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 B04M000440›BRIAN TANAKA

BRIAN TANAKA

Subscriber on policy B04M000440

Claims
3
Attributed to this person
Charged
1,674.00
Total submitted
Denied
1,057.00
2 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
NameBRIAN TANAKA
Role on the policySubscriber
PolicyB04M000440
Date of birth15 Mar 1984
PlanPLATINUM PPO
Covered from16 Feb 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00018878 May 2026617.00MERIDIAN HEALTH PLANNot denied—
CLM000188819 Oct 2024266.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING266.00
CLM000188926 Feb 2024791.00MERIDIAN HEALTH PLANCARC 18 · DUPLICATE791.00