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 B06M000463›IVAN EVANS

IVAN EVANS

Dependent on policy B06M000463

Claims
3
Attributed to this person
Charged
1,949.00
Total submitted
Denied
0.00
0 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
NameIVAN EVANS
Role on the policyDependent · relationship 01
PolicyB06M000463
Date of birth10 Sep 1994
PlanSILVER HMO
Covered from2 Aug 2024
Covered toopen

Patient responsibility reported on the 835

No patient responsibility reported on this person's remittances.

Care and denials

ClaimServiceChargedPayerOutcomeDenied
CLM000209619 Apr 2026749.00MERIDIAN HEALTH PLANNot denied—
CLM000209523 Mar 2026599.00MERIDIAN HEALTH PLANNot denied—
CLM00020972 Dec 2024601.00MERIDIAN HEALTH PLANNot denied—