GRACE USMAN
Subscriber on policy B10M000610
Claims
3
Attributed to this person
Charged
940.00
Total submitted
Denied
353.58
2 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 | GRACE USMAN |
| Role on the policy | Subscriber |
| Policy | B10M000610 |
| Date of birth | 27 Mar 1953 |
| Plan | BRONZE EPO |
| Covered from | 2 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002541 | 16 Nov 2025 | 114.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 114.00 |
| CLM0002540 | 6 Nov 2025 | 202.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002539 | 10 Oct 2025 | 624.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 239.58 |