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 B06M000158›DAVID PATEL

DAVID PATEL

Dependent on policy B06M000158

Claims
1
Attributed to this person
Charged
368.00
Total submitted
Denied
85.72
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
NameDAVID PATEL
Role on the policyDependent · relationship 19
PolicyB06M000158
Date of birth31 Aug 1990
PlanGOLD PPO
Covered from1 Mar 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000078918 May 2026368.00MERIDIAN HEALTH PLANCARC 96 · NON_COVERED85.72