IVAN EVANS
Dependent on policy B08M000375
Claims
2
Attributed to this person
Charged
928.00
Total submitted
Denied
832.00
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 | IVAN EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000375 |
| Date of birth | 3 Jun 2014 |
| Plan | SILVER HMO |
| Covered from | 13 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 |
|---|---|---|---|---|---|
| CLM0001716 | 17 Apr 2026 | 96.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001715 | 13 Jan 2025 | 832.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 832.00 |