RAVI HUGHES
Subscriber on policy B05M000095
Claims
2
Attributed to this person
Charged
1,421.00
Total submitted
Denied
575.00
1 denied claims
Patient responsibility
169.20
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 HUGHES |
| Role on the policy | Subscriber |
| Policy | B05M000095 |
| Date of birth | 13 Jun 1980 |
| Plan | PLATINUM PPO |
| Covered from | 13 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 169.20 |
| Total | 169.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000421 | 23 Feb 2024 | 846.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000420 | 31 Jan 2024 | 575.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 575.00 |