OMAR ANDERSON
Dependent on policy B04M000769
Claims
3
Attributed to this person
Charged
1,697.00
Total submitted
Denied
830.00
2 denied claims
Patient responsibility
328.25
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 | OMAR ANDERSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000769 |
| Date of birth | 21 Sep 1966 |
| Plan | BRONZE EPO |
| Covered from | 16 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 328.25 |
| Total | 328.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003348 | 3 Aug 2026 | 362.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003350 | 13 May 2025 | 830.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 830.00 |
| CLM0003349 | 22 Feb 2024 | 505.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |