PRIYA EVANS
Dependent on policy B04M000097
Claims
3
Attributed to this person
Charged
935.00
Total submitted
Denied
227.59
1 denied claims
Patient responsibility
47.70
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 EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000097 |
| Date of birth | 7 Mar 1990 |
| Plan | SILVER HMO |
| Covered from | 6 Dec 2024 |
| Covered to | 25 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 47.70 |
| Total | 47.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000443 | 14 Apr 2025 | 116.00 | CASCADE CARE | Not denied | — |
| CLM0000444 | 28 Jan 2025 | 501.00 | CASCADE CARE | CARC 11 · CODING | 227.59 |
| CLM0000442 | 19 Nov 2024 | 318.00 | CASCADE CARE | Not denied | — |