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›BRIAN PATEL

BRIAN PATEL

Dependent on policy B05M000118

Claims
2
Attributed to this person
Charged
1,095.00
Total submitted
Denied
951.44
2 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 PATEL
Role on the policyDependent · relationship 19
PolicyB05M000118
Date of birth19 Jan 2023
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
CLM000049426 May 2026879.00MERIDIAN HEALTH PLANCARC 197 · AUTHORIZATION879.00
CLM000049330 Nov 2025216.00MERIDIAN HEALTH PLANCARC 197 · AUTHORIZATION72.44