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 B06M000364›DAVID ANDERSON

DAVID ANDERSON

Dependent on policy B06M000364

Claims
2
Attributed to this person
Charged
1,074.00
Total submitted
Denied
402.00
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
NameDAVID ANDERSON
Role on the policyDependent · relationship 19
PolicyB06M000364
Date of birth20 Jul 1992
PlanBRONZE EPO
Covered from6 Apr 2024
Covered to7 Sep 2024

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM00016608 Jun 2024672.00MERIDIAN HEALTH PLANNot denied—
CLM00016595 Apr 2024402.00MERIDIAN HEALTH PLANCARC 26 · ELIGIBILITY402.00