SOFIA EVANS
Subscriber on policy B10M000295
Claims
3
Attributed to this person
Charged
1,120.00
Total submitted
Denied
889.00
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 | SOFIA EVANS |
| Role on the policy | Subscriber |
| Policy | B10M000295 |
| Date of birth | 6 Oct 2002 |
| Plan | BRONZE EPO |
| Covered from | 16 Mar 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0001231 | 1 Nov 2025 | 542.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 542.00 |
| CLM0001230 | 24 Jul 2025 | 347.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 347.00 |
| CLM0001229 | 3 Jul 2025 | 231.00 | NORTHSTAR MUTUAL | Not denied | — |