KEVIN EVANS
Subscriber on policy B05M000203
Claims
3
Attributed to this person
Charged
1,037.00
Total submitted
Denied
565.53
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 | KEVIN EVANS |
| Role on the policy | Subscriber |
| Policy | B05M000203 |
| Date of birth | 21 Dec 1993 |
| Plan | SILVER HMO |
| Covered from | 6 Mar 2024 |
| Covered to | 14 Aug 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000850 | 13 Oct 2024 | 95.00 | CASCADE CARE | Not denied | — |
| CLM0000851 | 8 Aug 2024 | 446.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 446.00 |
| CLM0000852 | 22 Apr 2024 | 496.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 119.53 |