X12 Ingest & Denial Analytics

Demo Environment — Synthetic Data OnlyThis application contains synthetic demonstration data only. Do not enter or submit patient information (PHI) or other sensitive personal information.
Members›policy B04M000359›IVAN OKAFOR

IVAN OKAFOR

Dependent on policy B04M000359

Claims
1
Attributed to this person
Charged
525.00
Total submitted
Denied
525.00
1 denied claims
Patient responsibility
0.00
Reported on the 835

Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.

Who this is

FieldValue
NameIVAN OKAFOR
Role on the policyDependent · relationship 01
PolicyB04M000359
Date of birth16 Mar 1993
PlanBRONZE EPO
Covered from13 Feb 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00015379 Feb 2026525.00MERIDIAN HEALTH PLANCARC 18 · DUPLICATE525.00