CARLA GARCIA
Subscriber on policy B10M000740
Claims
2
Attributed to this person
Charged
868.00
Total submitted
Denied
178.00
1 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 | CARLA GARCIA |
| Role on the policy | Subscriber |
| Policy | B10M000740 |
| Date of birth | 30 Aug 2001 |
| Plan | BRONZE EPO |
| Covered from | 8 Mar 2024 |
| Covered to | 16 Aug 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003105 | 3 Sep 2024 | 178.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 178.00 |
| CLM0003106 | 24 Jul 2024 | 690.00 | NORTHSTAR MUTUAL | Not denied | — |