RAVI WILSON
Subscriber on policy B04M000792
Claims
2
Attributed to this person
Charged
755.00
Total submitted
Denied
545.00
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 | RAVI WILSON |
| Role on the policy | Subscriber |
| Policy | B04M000792 |
| Date of birth | 16 Jan 1977 |
| Plan | SILVER HMO |
| Covered from | 8 May 2025 |
| Covered to | 20 Aug 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 |
|---|---|---|---|---|---|
| CLM0003455 | 1 Sep 2025 | 545.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 545.00 |
| CLM0003456 | 24 Jul 2025 | 210.00 | NORTHSTAR MUTUAL | Not denied | — |