UMA USMAN
Subscriber on policy B10M000252
Claims
3
Attributed to this person
Charged
1,682.00
Total submitted
Denied
17.30
1 denied claims
Patient responsibility
164.40
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 | Subscriber |
| Policy | B10M000252 |
| Date of birth | 7 Jan 1973 |
| Plan | PLATINUM PPO |
| Covered from | 16 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 164.40 |
| Total | 164.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001032 | 6 Jun 2026 | 822.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001034 | 16 Mar 2026 | 547.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 17.30 |
| CLM0001033 | 13 Apr 2025 | 313.00 | NORTHSTAR MUTUAL | Not denied | — |