ZARA EVANS
Dependent on policy B01M000276
Claims
3
Attributed to this person
Charged
726.00
Total submitted
Denied
61.00
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 | ZARA EVANS |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000276 |
| Date of birth | 13 Mar 1998 |
| Plan | PLATINUM PPO |
| Covered from | 31 Jan 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0001193 | 9 May 2026 | 148.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001191 | 7 May 2025 | 517.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001192 | 15 Jan 2025 | 61.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 61.00 |