NADIA HUGHES
Dependent on policy B06M000823
Claims
3
Attributed to this person
Charged
1,612.00
Total submitted
Denied
1,170.00
2 denied claims
Patient responsibility
25.00
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 | NADIA HUGHES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000823 |
| Date of birth | 26 Feb 1959 |
| Plan | SILVER HMO |
| Covered from | 30 Jan 2024 |
| Covered to | 17 Oct 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003604 | 6 Nov 2024 | 742.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 742.00 |
| CLM0003606 | 5 Sep 2024 | 442.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003605 | 16 May 2024 | 428.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 428.00 |