PRIYA KUMAR
Dependent on policy B09M000137
Claims
3
Attributed to this person
Charged
1,139.00
Total submitted
Denied
21.31
2 denied claims
Patient responsibility
436.15
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 | PRIYA KUMAR |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000137 |
| Date of birth | 21 Jun 1947 |
| Plan | GOLD PPO |
| Covered from | 21 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 436.15 |
| Total | 436.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000564 | 2 Mar 2026 | 671.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0000565 | 18 Dec 2025 | 73.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 21.31 |
| CLM0000566 | 13 Oct 2024 | 395.00 | NORTHSTAR MUTUAL | Not denied | — |