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 B05M000335›OMAR BAKER

OMAR BAKER

Subscriber on policy B05M000335

Claims
3
Attributed to this person
Charged
612.00
Total submitted
Denied
223.69
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
NameOMAR BAKER
Role on the policySubscriber
PolicyB05M000335
Date of birth1 Aug 1994
PlanGOLD PPO
Covered from31 Jan 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00014268 Jul 202665.00MERIDIAN HEALTH PLANCARC 18 · DUPLICATE65.00
CLM000142715 Feb 2026390.00MERIDIAN HEALTH PLANCARC 197 · AUTHORIZATION158.69
CLM000142521 Apr 2025157.00MERIDIAN HEALTH PLANNot denied—