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 B05M000337›ZARA BAKER

ZARA BAKER

Dependent on policy B05M000337

Claims
3
Attributed to this person
Charged
1,787.00
Total submitted
Denied
946.00
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
NameZARA BAKER
Role on the policyDependent · relationship 19
PolicyB05M000337
Date of birth24 Oct 2022
PlanPLATINUM PPO
Covered from5 Oct 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000143314 Dec 202586.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING86.00
CLM000143411 Sep 2025860.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING860.00
CLM000143213 Nov 2024841.00MERIDIAN HEALTH PLANNot denied—