UMA USMAN
Dependent on policy B10M000256
Claims
3
Attributed to this person
Charged
1,708.00
Total submitted
Denied
722.00
1 denied claims
Patient responsibility
147.90
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 | UMA USMAN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000256 |
| Date of birth | 22 Jun 2008 |
| Plan | PLATINUM PPO |
| Covered from | 12 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 2 | 147.90 |
| Total | 147.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001049 | 24 Dec 2024 | 346.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001047 | 16 Aug 2024 | 722.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 722.00 |
| CLM0001048 | 14 Mar 2024 | 640.00 | MERIDIAN HEALTH PLAN | Not denied | — |