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 B05M000497›LEILA FOSTER

LEILA FOSTER

Subscriber on policy B05M000497

Claims
1
Attributed to this person
Charged
686.00
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
NameLEILA FOSTER
Role on the policySubscriber
PolicyB05M000497
Date of birth14 Mar 1981
PlanPLATINUM PPO
Covered from2 Mar 2025
Covered to26 Dec 2025

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00021369 May 2025686.00MERIDIAN HEALTH PLANNot denied—