UMA USMAN
Dependent on policy B07M000364
Claims
3
Attributed to this person
Charged
2,173.00
Total submitted
Denied
457.00
1 denied claims
Patient responsibility
20.00
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 USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000364 |
| Date of birth | 15 May 1974 |
| Plan | PLATINUM PPO |
| Covered from | 19 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001550 | 25 Apr 2026 | 870.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001552 | 27 Sep 2025 | 457.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 457.00 |
| CLM0001551 | 16 Jan 2025 | 846.00 | NORTHSTAR MUTUAL | Not denied | — |