UMA WILSON
Dependent on policy B08M000287
Claims
3
Attributed to this person
Charged
946.00
Total submitted
Denied
500.00
1 denied claims
Patient responsibility
25.00
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 WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000287 |
| Date of birth | 13 Nov 1998 |
| Plan | SILVER HMO |
| Covered from | 9 Nov 2024 |
| Covered to | 31 May 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001310 | 13 Jun 2025 | 240.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001312 | 10 Mar 2025 | 206.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001311 | 21 Dec 2024 | 500.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 500.00 |