CARLA EVANS
Subscriber on policy B10M000827
Claims
1
Attributed to this person
Charged
853.00
Total submitted
Denied
253.13
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 | CARLA EVANS |
| Role on the policy | Subscriber |
| Policy | B10M000827 |
| Date of birth | 8 Jun 1985 |
| Plan | BRONZE EPO |
| Covered from | 27 Mar 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 |
|---|---|---|---|---|---|
| CLM0003502 | 25 Jan 2025 | 853.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 253.13 |