GRACE USMAN
Dependent on policy B10M000048
Claims
3
Attributed to this person
Charged
1,483.00
Total submitted
Denied
276.00
1 denied claims
Patient responsibility
63.00
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 | GRACE USMAN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000048 |
| Date of birth | 21 May 1993 |
| Plan | PLATINUM PPO |
| Covered from | 3 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 63.00 |
| Total | 63.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000187 | 16 Jun 2026 | 787.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000189 | 1 Jun 2025 | 420.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000188 | 9 Apr 2025 | 276.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 276.00 |