OMAR EVANS
Subscriber on policy B01M000669
Claims
2
Attributed to this person
Charged
728.00
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
| Field | Value |
|---|---|
| Name | OMAR EVANS |
| Role on the policy | Subscriber |
| Policy | B01M000669 |
| Date of birth | 27 Jan 1955 |
| Plan | SILVER HMO |
| Covered from | 9 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003002 | 29 Sep 2025 | 158.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003001 | 22 Jun 2024 | 570.00 | NORTHSTAR MUTUAL | Not denied | — |