KEVIN PATEL
Dependent on policy B06M000576
Claims
3
Attributed to this person
Charged
1,260.00
Total submitted
Denied
300.31
2 denied claims
Patient responsibility
254.55
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 PATEL |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000576 |
| Date of birth | 12 Mar 1988 |
| Plan | PLATINUM PPO |
| Covered from | 29 Dec 2024 |
| Covered to | 5 Apr 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 225.55 |
| CARC 2 · Coinsurance | 1 | 29.00 |
| Total | 254.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002580 | 2 Feb 2025 | 347.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0002579 | 16 Jan 2025 | 768.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 300.31 |
| CLM0002578 | 29 Nov 2024 | 145.00 | NORTHSTAR MUTUAL | Not denied | — |