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 B06M000288›CARLA ANDERSON

CARLA ANDERSON

Dependent on policy B06M000288

Claims
3
Attributed to this person
Charged
1,027.00
Total submitted
Denied
334.00
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
NameCARLA ANDERSON
Role on the policyDependent · relationship 01
PolicyB06M000288
Date of birth16 Sep 1945
PlanGOLD PPO
Covered from2 Apr 2025
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00013331 Aug 2026270.00MERIDIAN HEALTH PLANCARC 96 · NON_COVERED270.00
CLM00013349 Jul 2025693.00MERIDIAN HEALTH PLANNot denied—
CLM000133215 Mar 202564.00MERIDIAN HEALTH PLANCARC 26 · ELIGIBILITY64.00