OMAR HUGHES
Dependent on policy B08M000697
Claims
3
Attributed to this person
Charged
1,793.00
Total submitted
Denied
1,650.00
3 denied claims
Patient responsibility
92.95
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 HUGHES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000697 |
| Date of birth | 22 Dec 1979 |
| Plan | GOLD PPO |
| Covered from | 6 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 92.95 |
| Total | 92.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003146 | 15 Dec 2025 | 143.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0003144 | 6 Dec 2025 | 817.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 817.00 |
| CLM0003145 | 11 May 2025 | 833.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 833.00 |