PRIYA REYES
Subscriber on policy B04M000817
Claims
1
Attributed to this person
Charged
504.00
Total submitted
Denied
241.09
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 | PRIYA REYES |
| Role on the policy | Subscriber |
| Policy | B04M000817 |
| Date of birth | 17 Feb 1981 |
| Plan | PLATINUM PPO |
| Covered from | 11 Apr 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 |
|---|---|---|---|---|---|
| CLM0003560 | 2 May 2024 | 504.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 241.09 |