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.

UMA DIAZ

Dependent on policy B04M000432

Claims
2
Attributed to this person
Charged
1,363.00
Total submitted
Denied
468.00
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
NameUMA DIAZ
Role on the policyDependent · relationship 01
PolicyB04M000432
Date of birth3 Jan 1987
PlanSILVER HMO
Covered from18 Feb 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00018628 Jun 2026895.00MERIDIAN HEALTH PLANNot denied—
CLM000186316 Feb 2025468.00MERIDIAN HEALTH PLANCARC 26 · ELIGIBILITY468.00