GRACE EVANS
Subscriber on policy B07M000425
Claims
1
Attributed to this person
Charged
426.00
Total submitted
Denied
426.00
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 | GRACE EVANS |
| Role on the policy | Subscriber |
| Policy | B07M000425 |
| Date of birth | 11 May 1991 |
| Plan | PLATINUM PPO |
| Covered from | 11 Jan 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0001797 | 5 Feb 2025 | 426.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 426.00 |