OMAR REYES
Dependent on policy B10M000807
Claims
3
Attributed to this person
Charged
1,293.00
Total submitted
Denied
394.06
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 | OMAR REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000807 |
| Date of birth | 21 Aug 2014 |
| Plan | GOLD PPO |
| Covered from | 14 Oct 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0003411 | 6 Nov 2025 | 419.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 166.06 |
| CLM0003410 | 27 Sep 2025 | 228.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 228.00 |
| CLM0003409 | 8 Jan 2025 | 646.00 | NORTHSTAR MUTUAL | Not denied | — |