OMAR LOPEZ
Dependent on policy B06M000712
Claims
3
Attributed to this person
Charged
1,579.00
Total submitted
Denied
303.00
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 | OMAR LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000712 |
| Date of birth | 5 Nov 1983 |
| Plan | BRONZE EPO |
| Covered from | 8 Jun 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 |
|---|---|---|---|---|---|
| CLM0003175 | 1 Apr 2025 | 588.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003174 | 7 Feb 2025 | 688.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003173 | 11 Sep 2024 | 303.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 303.00 |