TOMAS KUMAR
Dependent on policy B10M000271
Claims
2
Attributed to this person
Charged
1,495.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
400.40
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 | TOMAS KUMAR |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000271 |
| Date of birth | 30 Nov 1949 |
| Plan | SILVER HMO |
| Covered from | 6 Jan 2024 |
| Covered to | 1 Aug 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 400.40 |
| Total | 400.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001127 | 25 Jan 2024 | 879.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001128 | 21 Dec 2023 | 616.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |