VICTOR EVANS
Subscriber on policy B08M000192
Claims
1
Attributed to this person
Charged
194.00
Total submitted
Denied
194.00
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 | VICTOR EVANS |
| Role on the policy | Subscriber |
| Policy | B08M000192 |
| Date of birth | 10 Oct 2004 |
| Plan | BRONZE EPO |
| Covered from | 25 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 |
|---|---|---|---|---|---|
| CLM0000850 | 24 Jan 2024 | 194.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 194.00 |