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 B05M000039›RAVI GARCIA

RAVI GARCIA

Subscriber on policy B05M000039

Claims
1
Attributed to this person
Charged
813.00
Total submitted
Denied
0.00
0 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
NameRAVI GARCIA
Role on the policySubscriber
PolicyB05M000039
Date of birth1 Jan 1961
PlanGOLD PPO
Covered from17 Dec 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000017823 Aug 2026813.00MERIDIAN HEALTH PLANNot denied—