AMARA EVANS
Subscriber on policy B02M000034
Claims
3
Attributed to this person
Charged
727.00
Total submitted
Denied
589.00
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 | AMARA EVANS |
| Role on the policy | Subscriber |
| Policy | B02M000034 |
| Date of birth | 5 Apr 1994 |
| Plan | GOLD PPO |
| Covered from | 2 Jan 2024 |
| Covered to | 7 Oct 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000170 | 15 Oct 2024 | 138.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000172 | 23 Jun 2024 | 161.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 161.00 |
| CLM0000171 | 1 Apr 2024 | 428.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 428.00 |