IVAN EVANS
Subscriber on policy B04M000427
Claims
2
Attributed to this person
Charged
830.00
Total submitted
Denied
539.00
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 | IVAN EVANS |
| Role on the policy | Subscriber |
| Policy | B04M000427 |
| Date of birth | 27 Oct 1953 |
| Plan | GOLD PPO |
| Covered from | 9 Feb 2025 |
| Covered to | 12 Apr 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001830 | 5 May 2025 | 539.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 539.00 |
| CLM0001831 | 23 Feb 2025 | 291.00 | NORTHSTAR MUTUAL | Not denied | — |