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 B01M000005›VICTOR PATEL

VICTOR PATEL

Subscriber on policy B01M000005

Claims
2
Attributed to this person
Charged
1,393.00
Total submitted
Denied
20.76
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
NameVICTOR PATEL
Role on the policySubscriber
PolicyB01M000005
Date of birth7 Dec 1954
PlanPLATINUM PPO
Covered from15 Jun 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00000166 Aug 2026571.00MERIDIAN HEALTH PLANCARC 197 · AUTHORIZATION20.76
CLM000001723 Jun 2025822.00MERIDIAN HEALTH PLANNot denied—