OMAR EVANS
Subscriber on policy B09M000300
Claims
3
Attributed to this person
Charged
1,246.00
Total submitted
Denied
742.00
2 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 | OMAR EVANS |
| Role on the policy | Subscriber |
| Policy | B09M000300 |
| Date of birth | 9 Feb 1966 |
| Plan | GOLD PPO |
| Covered from | 11 Apr 2024 |
| Covered to | 27 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 |
|---|---|---|---|---|---|
| CLM0001232 | 24 Oct 2024 | 287.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 287.00 |
| CLM0001230 | 7 May 2024 | 455.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 455.00 |
| CLM0001231 | 20 Apr 2024 | 504.00 | NORTHSTAR MUTUAL | Not denied | — |