OMAR EVANS
Dependent on policy B05M000148
Claims
3
Attributed to this person
Charged
1,543.00
Total submitted
Denied
560.00
1 denied claims
Patient responsibility
73.60
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 | OMAR EVANS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000148 |
| Date of birth | 25 Feb 1976 |
| Plan | SILVER HMO |
| Covered from | 20 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 73.60 |
| Total | 73.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000611 | 25 Aug 2026 | 560.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 560.00 |
| CLM0000613 | 26 Dec 2025 | 368.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000612 | 17 Oct 2025 | 615.00 | MERIDIAN HEALTH PLAN | Not denied | — |