SOFIA EVANS
Dependent on policy B04M000087
Claims
3
Attributed to this person
Charged
913.00
Total submitted
Denied
383.00
2 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 | SOFIA EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000087 |
| Date of birth | 3 Sep 1976 |
| Plan | GOLD PPO |
| Covered from | 4 Jun 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0000392 | 27 Feb 2026 | 530.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000390 | 17 Oct 2025 | 200.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 200.00 |
| CLM0000391 | 24 May 2025 | 183.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 183.00 |