RAVI ANDERSON
Dependent on policy B01M000731
Claims
3
Attributed to this person
Charged
1,455.00
Total submitted
Denied
316.00
1 denied claims
Patient responsibility
106.35
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 | RAVI ANDERSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000731 |
| Date of birth | 17 Jun 2022 |
| Plan | SILVER HMO |
| Covered from | 19 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 106.35 |
| Total | 106.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003251 | 1 Sep 2025 | 430.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003253 | 3 Jul 2025 | 316.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 316.00 |
| CLM0003252 | 6 Feb 2025 | 709.00 | NORTHSTAR MUTUAL | Not denied | — |