PRIYA WILSON
Dependent on policy B08M000069
Claims
1
Attributed to this person
Charged
637.00
Total submitted
Denied
637.00
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 | PRIYA WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000069 |
| Date of birth | 3 Nov 2000 |
| Plan | BRONZE EPO |
| Covered from | 21 Mar 2024 |
| Covered to | 5 Jun 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 |
|---|---|---|---|---|---|
| CLM0000311 | 21 Jun 2024 | 637.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 637.00 |