X12 Ingest & Denial Analytics

Demo Environment โ€” Synthetic Data OnlyThis application contains synthetic demonstration data only. Do not enter or submit patient information (PHI) or other sensitive personal information.

UMA QUINN

Subscriber on policy B05M000132

Claims
1
Attributed to this person
Charged
174.00
Total submitted
Denied
174.00
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 โ€” 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 QUINN
Role on the policySubscriber
PolicyB05M000132
Date of birth11 Jan 1993
PlanBRONZE EPO
Covered from1 Aug 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000054928 Feb 2026174.00NORTHSTAR MUTUALCARC 27 ยท ELIGIBILITY174.00