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.

UMA DIAZ

Dependent on policy B06M000308

Claims
3
Attributed to this person
Charged
1,093.00
Total submitted
Denied
292.00
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
NameUMA DIAZ
Role on the policyDependent · relationship 01
PolicyB06M000308
Date of birth1 Apr 1966
PlanBRONZE EPO
Covered from17 May 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000141224 Dec 2025292.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY292.00
CLM00014142 Dec 2025411.00MERIDIAN HEALTH PLANNot denied—
CLM000141310 Jul 2024390.00MERIDIAN HEALTH PLANNot denied—