TOMAS EVANS
Dependent on policy B09M000694
Claims
1
Attributed to this person
Charged
885.00
Total submitted
Denied
885.00
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 | TOMAS EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000694 |
| Date of birth | 29 Nov 1998 |
| Plan | SILVER HMO |
| Covered from | 20 May 2024 |
| Covered to | 5 Sep 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 |
|---|---|---|---|---|---|
| CLM0002958 | 9 Aug 2024 | 885.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 885.00 |