OMAR QUINN
Subscriber on policy B08M000161
Claims
3
Attributed to this person
Charged
1,464.00
Total submitted
Denied
1,222.00
2 denied claims
Patient responsibility
40.00
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 QUINN |
| Role on the policy | Subscriber |
| Policy | B08M000161 |
| Date of birth | 25 Oct 1982 |
| Plan | BRONZE EPO |
| Covered from | 19 Jun 2024 |
| Covered to | 2 Oct 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 40.00 |
| Total | 40.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000733 | 21 Nov 2024 | 898.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 898.00 |
| CLM0000734 | 1 Nov 2024 | 324.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 324.00 |
| CLM0000735 | 2 Jun 2024 | 242.00 | NORTHSTAR MUTUAL | Not denied | — |