PRIYA EVANS
Dependent on policy B03M000491
Claims
2
Attributed to this person
Charged
1,372.00
Total submitted
Denied
595.93
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 | PRIYA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000491 |
| Date of birth | 8 May 1980 |
| Plan | PLATINUM PPO |
| Covered from | 9 Oct 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 |
|---|---|---|---|---|---|
| CLM0002041 | 18 Dec 2025 | 584.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 584.00 |
| CLM0002042 | 28 Mar 2025 | 788.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 11.93 |