OMAR EVANS
Subscriber on policy B10M000311
Claims
2
Attributed to this person
Charged
1,300.00
Total submitted
Denied
822.00
2 denied claims
Patient responsibility
310.70
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 | B10M000311 |
| Date of birth | 24 Jun 2004 |
| Plan | BRONZE EPO |
| Covered from | 26 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 310.70 |
| Total | 310.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001307 | 8 Dec 2025 | 822.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 822.00 |
| CLM0001306 | 11 Oct 2025 | 478.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |