PRIYA USMAN
Subscriber on policy B06M000246
Claims
3
Attributed to this person
Charged
1,190.00
Total submitted
Denied
307.77
2 denied claims
Patient responsibility
99.60
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 | PRIYA USMAN |
| Role on the policy | Subscriber |
| Policy | B06M000246 |
| Date of birth | 20 Jun 1952 |
| Plan | BRONZE EPO |
| Covered from | 5 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 99.60 |
| Total | 99.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001170 | 13 Dec 2025 | 114.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 114.00 |
| CLM0001172 | 30 Nov 2024 | 412.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 193.77 |
| CLM0001171 | 21 Aug 2024 | 664.00 | NORTHSTAR MUTUAL | Not denied | — |