BRIAN EVANS
Dependent on policy B01M000268
Claims
2
Attributed to this person
Charged
940.00
Total submitted
Denied
600.84
2 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 | BRIAN EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000268 |
| Date of birth | 2 Oct 1992 |
| Plan | SILVER HMO |
| Covered from | 13 Jun 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 |
|---|---|---|---|---|---|
| CLM0001149 | 9 Apr 2026 | 635.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 295.84 |
| CLM0001150 | 13 Nov 2024 | 305.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 305.00 |