PRIYA LOPEZ
Subscriber on policy B10M000658
Claims
2
Attributed to this person
Charged
626.00
Total submitted
Denied
626.00
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 | PRIYA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B10M000658 |
| Date of birth | 10 Nov 1992 |
| Plan | SILVER HMO |
| Covered from | 15 Jan 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 |
|---|---|---|---|---|---|
| CLM0002727 | 21 Mar 2025 | 237.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 237.00 |
| CLM0002725 | 27 Feb 2025 | 389.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 389.00 |