GRACE USMAN
Subscriber on policy B07M000208
Claims
3
Attributed to this person
Charged
933.00
Total submitted
Denied
131.00
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 | GRACE USMAN |
| Role on the policy | Subscriber |
| Policy | B07M000208 |
| Date of birth | 7 Jul 1971 |
| Plan | SILVER HMO |
| Covered from | 23 May 2024 |
| Covered to | 11 Jan 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000872 | 30 Dec 2024 | 131.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 131.00 |
| CLM0000870 | 28 Oct 2024 | 344.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000871 | 27 May 2024 | 458.00 | NORTHSTAR MUTUAL | Not denied | — |