MARCUS EVANS
Subscriber on policy B02M000310
Claims
3
Attributed to this person
Charged
1,616.00
Total submitted
Denied
593.00
1 denied claims
Patient responsibility
25.00
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 | MARCUS EVANS |
| Role on the policy | Subscriber |
| Policy | B02M000310 |
| Date of birth | 13 Apr 1971 |
| Plan | GOLD PPO |
| Covered from | 14 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001329 | 7 Sep 2025 | 789.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001330 | 26 Jan 2025 | 234.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001331 | 21 Sep 2024 | 593.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 593.00 |