RAVI EVANS
Subscriber on policy B01M000546
Claims
2
Attributed to this person
Charged
1,217.00
Total submitted
Denied
692.00
1 denied claims
Patient responsibility
105.00
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 | RAVI EVANS |
| Role on the policy | Subscriber |
| Policy | B01M000546 |
| Date of birth | 27 Aug 1971 |
| Plan | PLATINUM PPO |
| Covered from | 20 Apr 2025 |
| Covered to | 17 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 105.00 |
| Total | 105.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002454 | 15 Aug 2025 | 525.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002455 | 24 Apr 2025 | 692.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 692.00 |