IVAN WILSON
Subscriber on policy B02M000055
Claims
1
Attributed to this person
Charged
813.00
Total submitted
Denied
813.00
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 | IVAN WILSON |
| Role on the policy | Subscriber |
| Policy | B02M000055 |
| Date of birth | 6 May 1984 |
| Plan | PLATINUM PPO |
| Covered from | 24 Feb 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 |
|---|---|---|---|---|---|
| CLM0000253 | 5 Jul 2025 | 813.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 813.00 |