RAVI EVANS
Dependent on policy B04M000854
Claims
3
Attributed to this person
Charged
1,388.00
Total submitted
Denied
839.00
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 EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000854 |
| Date of birth | 27 Jul 1973 |
| Plan | BRONZE EPO |
| Covered from | 1 Mar 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 |
|---|---|---|---|---|---|
| CLM0003693 | 11 Jul 2025 | 463.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003692 | 18 Jun 2025 | 86.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003694 | 17 Feb 2024 | 839.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 839.00 |