GRACE GARCIA
Subscriber on policy B06M000078
Claims
1
Attributed to this person
Charged
736.00
Total submitted
Denied
736.00
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 | GRACE GARCIA |
| Role on the policy | Subscriber |
| Policy | B06M000078 |
| Date of birth | 18 Dec 1998 |
| Plan | SILVER HMO |
| Covered from | 23 Jul 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 |
|---|---|---|---|---|---|
| CLM0000409 | 25 Oct 2024 | 736.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 736.00 |