Policy B03M000138
5 people enrolled on this policy.
People
5
On this policy
Claims attributed
13
To a named person
Policy-level
0
Not attributed to a person
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.
People on this policy
| Name | Role | Born | Claims | Denials | Denied | Patient responsibility (835) |
|---|---|---|---|---|---|---|
| TOMAS EVANS | Subscriber | 13 Oct 1980 | 3 | 1 | 771.00 | 0.00 |
| OMAR EVANS | Dependent · 01 | 3 Dec 1971 | 3 | 1 | 218.69 | 0.00 |
| WENDY EVANS | Dependent · 19 | 18 Apr 2003 | 2 | 1 | 682.00 | 0.00 |
| LEILA EVANS | Dependent · 19 | 27 Nov 2010 | 2 | 0 | 0.00 | 0.00 |
| TOMAS EVANS | Dependent · 19 | 31 Dec 2012 | 3 | 2 | 144.00 | 313.30 |
Policy-level claims
Every claim on this policy is attributed to a named person.
Claims are attributed to a person from the patient loop of the 837P — name, date of birth and relationship within the policy — because the transaction carries no patient identifier. A claim that matches nobody, or more than one person, stays with the policy and is shown there rather than being assigned to a guess.