PRIYA EVANS
Subscriber on policy B02M000611
Claims
3
Attributed to this person
Charged
2,035.00
Total submitted
Denied
514.00
1 denied claims
Patient responsibility
126.80
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 | Subscriber |
| Policy | B02M000611 |
| Date of birth | 13 Jun 2001 |
| Plan | SILVER HMO |
| Covered from | 15 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 126.80 |
| Total | 126.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002570 | 7 Jul 2025 | 887.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002571 | 25 Jan 2025 | 514.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 514.00 |
| CLM0002569 | 2 Jul 2024 | 634.00 | NORTHSTAR MUTUAL | Not denied | — |