OMAR EVANS
Subscriber on policy B02M000149
Claims
3
Attributed to this person
Charged
924.00
Total submitted
Denied
27.84
2 denied claims
Patient responsibility
240.50
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 | B02M000149 |
| Date of birth | 24 Nov 1996 |
| Plan | PLATINUM PPO |
| Covered from | 17 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 240.50 |
| Total | 240.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000676 | 15 Feb 2026 | 370.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |
| CLM0000675 | 11 Dec 2025 | 474.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000677 | 23 May 2025 | 80.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 27.84 |