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 B06M000323›ZARA EVANS

ZARA EVANS

Subscriber on policy B06M000323

Claims
3
Attributed to this person
Charged
1,234.00
Total submitted
Denied
1,234.00
3 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
NameZARA EVANS
Role on the policySubscriber
PolicyB06M000323
Date of birth23 Sep 1996
PlanPLATINUM PPO
Covered from9 Dec 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00014737 Mar 2026449.00MERIDIAN HEALTH PLANCARC 29 · TIMELY_FILING449.00
CLM000147519 Dec 2025495.00MERIDIAN HEALTH PLANCARC 197 · AUTHORIZATION495.00
CLM00014748 Oct 2025290.00MERIDIAN HEALTH PLANCARC 27 · ELIGIBILITY290.00