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 B05M000118›HENRY PATEL

HENRY PATEL

Subscriber on policy B05M000118

Claims
2
Attributed to this person
Charged
617.00
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
NameHENRY PATEL
Role on the policySubscriber
PolicyB05M000118
Date of birth12 Dec 1994
PlanGOLD PPO
Covered from22 Feb 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00004899 Mar 202585.00MERIDIAN HEALTH PLANNot denied—
CLM000048813 Jan 2025532.00MERIDIAN HEALTH PLANNot denied—