NADIA REYES
Dependent on policy B09M000023
Claims
3
Attributed to this person
Charged
1,436.00
Total submitted
Denied
138.63
2 denied claims
Patient responsibility
333.45
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 | NADIA REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000023 |
| Date of birth | 23 Mar 1970 |
| Plan | PLATINUM PPO |
| Covered from | 23 Oct 2024 |
| Covered to | 13 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 333.45 |
| Total | 333.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000095 | 5 Feb 2025 | 513.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000094 | 20 Jan 2025 | 644.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000096 | 29 Oct 2024 | 279.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 138.63 |