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 B04M000712›WENDY REYES

WENDY REYES

Subscriber on policy B04M000712

Claims
3
Attributed to this person
Charged
1,173.00
Total submitted
Denied
170.00
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
NameWENDY REYES
Role on the policySubscriber
PolicyB04M000712
Date of birth6 Apr 1984
PlanBRONZE EPO
Covered from18 Apr 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000309418 Jul 2026385.00MERIDIAN HEALTH PLANNot denied—
CLM000309225 Jul 2025170.00MERIDIAN HEALTH PLANCARC 11 · CODING170.00
CLM00030932 Jun 2024618.00MERIDIAN HEALTH PLANNot denied—