NADIA EVANS
Dependent on policy B05M000512
Claims
2
Attributed to this person
Charged
944.00
Total submitted
Denied
260.00
1 denied claims
Patient responsibility
102.60
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 | NADIA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000512 |
| Date of birth | 25 Mar 2019 |
| Plan | BRONZE EPO |
| Covered from | 13 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 102.60 |
| Total | 102.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002201 | 11 Aug 2025 | 684.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002200 | 10 Aug 2025 | 260.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 260.00 |