KEVIN EVANS
Subscriber on policy B03M000603
Claims
3
Attributed to this person
Charged
1,515.00
Total submitted
Denied
890.00
2 denied claims
Patient responsibility
348.40
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 | KEVIN EVANS |
| Role on the policy | Subscriber |
| Policy | B03M000603 |
| Date of birth | 9 Nov 1980 |
| Plan | SILVER HMO |
| Covered from | 15 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 348.40 |
| Total | 348.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002480 | 21 Jun 2026 | 89.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002481 | 18 Aug 2025 | 890.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 890.00 |
| CLM0002479 | 6 Jul 2025 | 536.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |