OMAR HUGHES
Subscriber on policy B09M000869
Claims
3
Attributed to this person
Charged
1,695.00
Total submitted
Denied
952.07
2 denied claims
Patient responsibility
49.60
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 | Subscriber |
| Policy | B09M000869 |
| Date of birth | 1 Jan 1995 |
| Plan | GOLD PPO |
| Covered from | 14 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 49.60 |
| Total | 49.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003686 | 11 May 2025 | 637.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 142.07 |
| CLM0003685 | 3 Feb 2025 | 810.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 810.00 |
| CLM0003687 | 1 Jul 2024 | 248.00 | NORTHSTAR MUTUAL | Not denied | — |