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 B05M000013›BRIAN USMAN

BRIAN USMAN

Dependent on policy B05M000013

Claims
1
Attributed to this person
Charged
261.00
Total submitted
Denied
121.61
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
NameBRIAN USMAN
Role on the policyDependent · relationship 01
PolicyB05M000013
Date of birth6 Apr 1997
PlanGOLD PPO
Covered from24 Jul 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000004417 Nov 2025261.00MERIDIAN HEALTH PLANCARC 96 · NON_COVERED121.61