OMAR REYES
Subscriber on policy B08M000107
Claims
1
Attributed to this person
Charged
263.00
Total submitted
Denied
84.33
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 | OMAR REYES |
| Role on the policy | Subscriber |
| Policy | B08M000107 |
| Date of birth | 18 Dec 1956 |
| Plan | GOLD PPO |
| Covered from | 10 Jun 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 |
|---|---|---|---|---|---|
| CLM0000468 | 26 Aug 2025 | 263.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 84.33 |