RAVI WILSON
Dependent on policy B03M000813
Claims
1
Attributed to this person
Charged
124.00
Total submitted
Denied
42.58
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 | RAVI WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000813 |
| Date of birth | 23 Apr 1956 |
| Plan | BRONZE EPO |
| Covered from | 13 Aug 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 |
|---|---|---|---|---|---|
| CLM0003500 | 3 Oct 2024 | 124.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 42.58 |