PRIYA EVANS
Dependent on policy B09M000096
Claims
1
Attributed to this person
Charged
746.00
Total submitted
Denied
209.33
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 | PRIYA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000096 |
| Date of birth | 2 Jul 1986 |
| Plan | BRONZE EPO |
| Covered from | 4 Jan 2024 |
| Covered to | 23 Mar 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 |
|---|---|---|---|---|---|
| CLM0000397 | 13 Jan 2024 | 746.00 | CASCADE CARE | CARC 96 · NON_COVERED | 209.33 |