TOMAS EVANS
Subscriber on policy B03M000771
Claims
1
Attributed to this person
Charged
700.00
Total submitted
Denied
700.00
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 | TOMAS EVANS |
| Role on the policy | Subscriber |
| Policy | B03M000771 |
| Date of birth | 23 Jul 2000 |
| Plan | PLATINUM PPO |
| Covered from | 28 Feb 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 |
|---|---|---|---|---|---|
| CLM0003259 | 22 Apr 2024 | 700.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 700.00 |