PRIYA EVANS
Dependent on policy B02M000176
Claims
3
Attributed to this person
Charged
1,971.00
Total submitted
Denied
820.00
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 | PRIYA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000176 |
| Date of birth | 4 Jun 1980 |
| Plan | SILVER HMO |
| Covered from | 28 Nov 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 |
|---|---|---|---|---|---|
| CLM0000792 | 23 Jul 2026 | 820.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 820.00 |
| CLM0000794 | 6 Mar 2025 | 751.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000793 | 18 Feb 2025 | 400.00 | NORTHSTAR MUTUAL | Not denied | — |