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 B05M000193›AMARA PATEL

AMARA PATEL

Dependent on policy B05M000193

Claims
1
Attributed to this person
Charged
103.00
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
NameAMARA PATEL
Role on the policyDependent · relationship 19
PolicyB05M000193
Date of birth15 May 2023
PlanGOLD PPO
Covered from5 Mar 2025
Covered to6 May 2025

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000081719 Mar 2025103.00MERIDIAN HEALTH PLANNot denied—