TOMAS EVANS
Dependent on policy B09M000435
Claims
3
Attributed to this person
Charged
939.00
Total submitted
Denied
559.14
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 | TOMAS EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000435 |
| Date of birth | 14 Jun 1987 |
| Plan | SILVER HMO |
| Covered from | 19 Jun 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 |
|---|---|---|---|---|---|
| CLM0001823 | 2 Apr 2026 | 282.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001822 | 20 Aug 2025 | 509.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 509.00 |
| CLM0001821 | 1 Jul 2024 | 148.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 50.14 |