OMAR WILSON
Dependent on policy B07M000601
Claims
3
Attributed to this person
Charged
1,409.00
Total submitted
Denied
625.00
2 denied claims
Patient responsibility
382.85
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 | OMAR WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000601 |
| Date of birth | 3 May 2016 |
| Plan | BRONZE EPO |
| Covered from | 19 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 382.85 |
| Total | 382.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002532 | 23 Jul 2025 | 195.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002531 | 29 Apr 2025 | 625.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 625.00 |
| CLM0002530 | 1 Apr 2025 | 589.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |