PRIYA EVANS
Dependent on policy B10M000167
Claims
2
Attributed to this person
Charged
1,045.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
501.80
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 19 |
| Policy | B10M000167 |
| Date of birth | 2 Sep 2023 |
| Plan | SILVER HMO |
| Covered from | 25 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 501.80 |
| Total | 501.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000702 | 31 Dec 2025 | 772.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0000703 | 20 Apr 2025 | 273.00 | NORTHSTAR MUTUAL | Not denied | — |