NADIA REYES
Dependent on policy B10M000807
Claims
2
Attributed to this person
Charged
1,227.00
Total submitted
Denied
166.34
2 denied claims
Patient responsibility
352.30
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 | NADIA REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000807 |
| Date of birth | 8 Mar 2012 |
| Plan | GOLD PPO |
| Covered from | 14 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 352.30 |
| Total | 352.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003413 | 2 Mar 2026 | 685.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 166.34 |
| CLM0003412 | 13 Jan 2025 | 542.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |