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 B04M000363›VICTOR BAKER

VICTOR BAKER

Subscriber on policy B04M000363

Claims
1
Attributed to this person
Charged
124.00
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 BAKER
Role on the policySubscriber
PolicyB04M000363
Date of birth5 Jan 1975
PlanPLATINUM PPO
Covered from29 Apr 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000155825 Jan 2026124.00MERIDIAN HEALTH PLANNot denied—