ELENA WILSON
Subscriber on policy B06M000830
Claims
2
Attributed to this person
Charged
656.00
Total submitted
Denied
132.00
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 | ELENA WILSON |
| Role on the policy | Subscriber |
| Policy | B06M000830 |
| Date of birth | 8 Jun 1987 |
| Plan | BRONZE EPO |
| Covered from | 30 Apr 2024 |
| Covered to | 14 Oct 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003629 | 9 Nov 2024 | 132.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 132.00 |
| CLM0003628 | 7 Jul 2024 | 524.00 | NORTHSTAR MUTUAL | Not denied | — |