UMA EVANS
Dependent on policy B04M000271
Claims
1
Attributed to this person
Charged
127.00
Total submitted
Denied
127.00
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 | UMA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000271 |
| Date of birth | 30 May 1999 |
| Plan | PLATINUM PPO |
| Covered from | 21 Mar 2024 |
| Covered to | 25 Jun 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001173 | 12 Apr 2024 | 127.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 127.00 |