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 B05M000002›MARCUS DIAZ

MARCUS DIAZ

Subscriber on policy B05M000002

Claims
3
Attributed to this person
Charged
2,508.00
Total submitted
Denied
398.49
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
NameMARCUS DIAZ
Role on the policySubscriber
PolicyB05M000002
Date of birth26 Apr 2003
PlanSILVER HMO
Covered from29 Mar 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000000811 Aug 2026789.00MERIDIAN HEALTH PLANNot denied—
CLM000001011 Apr 2025824.00MERIDIAN HEALTH PLANNot denied—
CLM000000924 Dec 2024895.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING398.49