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 B05M000410›ELENA FOSTER

ELENA FOSTER

Dependent on policy B05M000410

Claims
1
Attributed to this person
Charged
470.00
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
NameELENA FOSTER
Role on the policyDependent · relationship 19
PolicyB05M000410
Date of birth3 Oct 2002
PlanGOLD PPO
Covered from18 Feb 2025
Covered to27 Apr 2025

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00017444 Feb 2025470.00MERIDIAN HEALTH PLANNot denied—