UMA LOPEZ
Subscriber on policy B07M000750
Claims
3
Attributed to this person
Charged
1,813.00
Total submitted
Denied
1,467.00
2 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 | UMA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B07M000750 |
| Date of birth | 18 Sep 1984 |
| Plan | BRONZE EPO |
| Covered from | 28 Jan 2024 |
| Covered to | 24 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 |
|---|---|---|---|---|---|
| CLM0003103 | 12 Jul 2024 | 625.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 625.00 |
| CLM0003104 | 11 May 2024 | 346.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003105 | 29 Mar 2024 | 842.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 842.00 |