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 B05M000139›PRIYA CHEN

PRIYA CHEN

Dependent on policy B05M000139

Claims
2
Attributed to this person
Charged
548.00
Total submitted
Denied
394.73
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
NamePRIYA CHEN
Role on the policyDependent · relationship 19
PolicyB05M000139
Date of birth3 Apr 1979
PlanPLATINUM PPO
Covered from13 Feb 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000056827 Jun 2025179.00MERIDIAN HEALTH PLANCARC 197 · AUTHORIZATION25.73
CLM000056922 Jan 2025369.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING369.00