TOMAS EVANS
Dependent on policy B02M000540
Claims
3
Attributed to this person
Charged
1,687.00
Total submitted
Denied
1,201.00
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 | TOMAS EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000540 |
| Date of birth | 26 Sep 1980 |
| Plan | SILVER HMO |
| Covered from | 13 Sep 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 |
|---|---|---|---|---|---|
| CLM0002282 | 19 May 2026 | 486.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002284 | 29 Jul 2025 | 595.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 595.00 |
| CLM0002283 | 25 Oct 2024 | 606.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 606.00 |