PRIYA WILSON
Dependent on policy B04M000792
Claims
1
Attributed to this person
Charged
71.00
Total submitted
Denied
71.00
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 | PRIYA WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000792 |
| Date of birth | 16 Mar 2004 |
| 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 |
|---|---|---|---|---|---|
| CLM0003459 | 24 Apr 2025 | 71.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 71.00 |