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 B06M000123›DAVID GARCIA

DAVID GARCIA

Subscriber on policy B06M000123

Claims
2
Attributed to this person
Charged
1,148.00
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
NameDAVID GARCIA
Role on the policySubscriber
PolicyB06M000123
Date of birth3 Apr 1973
PlanBRONZE EPO
Covered from28 Apr 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000060714 Jun 2026595.00MERIDIAN HEALTH PLANNot denied—
CLM000060624 Apr 2025553.00MERIDIAN HEALTH PLANNot denied—