KEVIN USMAN
Subscriber on policy B08M000701
Claims
3
Attributed to this person
Charged
1,124.00
Total submitted
Denied
1,059.00
2 denied claims
Patient responsibility
13.00
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 | KEVIN USMAN |
| Role on the policy | Subscriber |
| Policy | B08M000701 |
| Date of birth | 23 Feb 1964 |
| Plan | SILVER HMO |
| Covered from | 4 Apr 2025 |
| Covered to | 15 Nov 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 13.00 |
| Total | 13.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003160 | 13 Jan 2026 | 65.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003161 | 7 Dec 2025 | 203.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 203.00 |
| CLM0003159 | 18 Jun 2025 | 856.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 856.00 |