UMA LOPEZ
Subscriber on policy B10M000723
Claims
1
Attributed to this person
Charged
674.00
Total submitted
Denied
674.00
1 denied claims
Patient responsibility
0.00
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 | UMA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B10M000723 |
| Date of birth | 8 Sep 1951 |
| Plan | PLATINUM PPO |
| Covered from | 24 Jan 2024 |
| Covered to | 7 Jul 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003035 | 9 Jun 2024 | 674.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 674.00 |