WENDY FOSTER
Dependent on policy B07M000004
Claims
3
Attributed to this person
Charged
1,571.00
Total submitted
Denied
399.00
2 denied claims
Patient responsibility
327.60
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 | WENDY FOSTER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000004 |
| Date of birth | 16 Jan 1993 |
| Plan | BRONZE EPO |
| Covered from | 22 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 327.60 |
| Total | 327.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000025 | 5 May 2025 | 504.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000024 | 23 Feb 2025 | 668.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000023 | 25 Jan 2025 | 399.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 399.00 |