DAVID PATEL
Dependent on policy B07M000303
Claims
3
Attributed to this person
Charged
1,367.00
Total submitted
Denied
1,109.66
3 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 | DAVID PATEL |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000303 |
| Date of birth | 27 Aug 1975 |
| Plan | GOLD PPO |
| Covered from | 21 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001306 | 19 Nov 2025 | 169.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 169.00 |
| CLM0001307 | 23 Jan 2025 | 342.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 84.66 |
| CLM0001308 | 1 Nov 2024 | 856.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 856.00 |