OMAR ANDERSON
Subscriber on policy B05M000574
Claims
1
Attributed to this person
Charged
446.00
Total submitted
Denied
446.00
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 | OMAR ANDERSON |
| Role on the policy | Subscriber |
| Policy | B05M000574 |
| Date of birth | 3 Feb 1951 |
| Plan | GOLD PPO |
| Covered from | 28 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 |
|---|---|---|---|---|---|
| CLM0002440 | 31 May 2024 | 446.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 446.00 |