VICTOR EVANS
Subscriber on policy B03M000063
Claims
2
Attributed to this person
Charged
1,368.00
Total submitted
Denied
1,368.00
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 | VICTOR EVANS |
| Role on the policy | Subscriber |
| Policy | B03M000063 |
| Date of birth | 22 Aug 1990 |
| Plan | GOLD PPO |
| Covered from | 17 Nov 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 |
|---|---|---|---|---|---|
| CLM0000273 | 24 Oct 2025 | 695.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 695.00 |
| CLM0000274 | 17 May 2025 | 673.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 673.00 |