OMAR EVANS
Dependent on policy B06M000529
Claims
1
Attributed to this person
Charged
121.00
Total submitted
Denied
121.00
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
| Field | Value |
|---|---|
| Name | OMAR EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000529 |
| Date of birth | 6 Feb 1963 |
| Plan | PLATINUM PPO |
| Covered from | 9 Jan 2024 |
| Covered to | 17 Aug 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002358 | 8 Oct 2024 | 121.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 121.00 |