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.

UMA BAKER

Dependent on policy B05M000369

Claims
2
Attributed to this person
Charged
1,466.00
Total submitted
Denied
653.00
1 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
NameUMA BAKER
Role on the policyDependent · relationship 01
PolicyB05M000369
Date of birth15 Jan 2005
PlanPLATINUM PPO
Covered from26 May 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00015714 Jul 2026813.00MERIDIAN HEALTH PLANNot denied—
CLM00015725 Jan 2026653.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY653.00