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 B04M000362›VICTOR OKAFOR

VICTOR OKAFOR

Dependent on policy B04M000362

Claims
1
Attributed to this person
Charged
429.00
Total submitted
Denied
0.00
0 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
NameVICTOR OKAFOR
Role on the policyDependent · relationship 01
PolicyB04M000362
Date of birth19 Jan 1966
PlanSILVER HMO
Covered from15 Aug 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00015559 Sep 2025429.00MERIDIAN HEALTH PLANNot denied—