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 B05M000492›HENRY QUINN

HENRY QUINN

Subscriber on policy B05M000492

Claims
3
Attributed to this person
Charged
1,925.00
Total submitted
Denied
1,192.00
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
NameHENRY QUINN
Role on the policySubscriber
PolicyB05M000492
Date of birth29 Jul 1975
PlanGOLD PPO
Covered from2 May 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000210031 Jul 2026733.00NORTHSTAR MUTUALNot denied—
CLM000210120 Jan 2025407.00NORTHSTAR MUTUALCARC 27 · ELIGIBILITY407.00
CLM00021025 Apr 2024785.00NORTHSTAR MUTUALCARC 18 · DUPLICATE785.00