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 B01M000348›MARCUS YAMADA

MARCUS YAMADA

Dependent on policy B01M000348

Claims
3
Attributed to this person
Charged
430.00
Total submitted
Denied
207.13
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
NameMARCUS YAMADA
Role on the policyDependent · relationship 01
PolicyB01M000348
Date of birth31 Jan 2008
PlanGOLD PPO
Covered from17 Jun 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000153617 Dec 202587.00NORTHSTAR MUTUALCARC 27 · ELIGIBILITY41.13
CLM000153529 Jun 2025177.00NORTHSTAR MUTUALNot denied—
CLM00015374 Jun 2024166.00NORTHSTAR MUTUALCARC 26 · ELIGIBILITY166.00