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 B04M000434›LEILA REYES

LEILA REYES

Dependent on policy B04M000434

Claims
2
Attributed to this person
Charged
1,618.00
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
NameLEILA REYES
Role on the policyDependent · relationship 01
PolicyB04M000434
Date of birth30 Sep 1994
PlanGOLD PPO
Covered from29 Apr 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000187325 Jan 2026841.00MERIDIAN HEALTH PLANNot denied—
CLM000187419 Dec 2024777.00MERIDIAN HEALTH PLANNot denied—