ZARA EVANS
Dependent on policy B09M000300
Claims
2
Attributed to this person
Charged
1,252.00
Total submitted
Denied
323.21
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 | ZARA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000300 |
| Date of birth | 7 Oct 1963 |
| 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 |
|---|---|---|---|---|---|
| CLM0001233 | 18 Sep 2024 | 691.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 323.21 |
| CLM0001234 | 24 May 2024 | 561.00 | NORTHSTAR MUTUAL | Not denied | — |