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 B05M000517›NADIA HUGHES

NADIA HUGHES

Dependent on policy B05M000517

Claims
2
Attributed to this person
Charged
942.00
Total submitted
Denied
622.00
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 — 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
NameNADIA HUGHES
Role on the policyDependent · relationship 01
PolicyB05M000517
Date of birth21 Jul 1969
PlanGOLD PPO
Covered from22 May 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000222429 Sep 2024320.00NORTHSTAR MUTUALNot denied—
CLM000222526 Apr 2024622.00NORTHSTAR MUTUALCARC 18 · DUPLICATE622.00