TOMAS FOSTER
Dependent on policy B08M000684
Claims
3
Attributed to this person
Charged
1,911.00
Total submitted
Denied
1,410.00
2 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 | TOMAS FOSTER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000684 |
| Date of birth | 8 Jan 1973 |
| Plan | GOLD PPO |
| Covered from | 5 Mar 2024 |
| Covered to | 6 Nov 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003091 | 21 Oct 2024 | 860.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 860.00 |
| CLM0003092 | 14 Sep 2024 | 501.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003090 | 28 Feb 2024 | 550.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 550.00 |