ZARA GARCIA
Dependent on policy B02M000123
Claims
3
Attributed to this person
Charged
557.00
Total submitted
Denied
214.00
2 denied claims
Patient responsibility
53.30
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 | ZARA GARCIA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000123 |
| Date of birth | 25 Nov 1988 |
| Plan | GOLD PPO |
| Covered from | 8 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 53.30 |
| Total | 53.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000560 | 13 Apr 2026 | 214.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 214.00 |
| CLM0000562 | 6 Jan 2026 | 82.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0000561 | 4 Jan 2026 | 261.00 | NORTHSTAR MUTUAL | Not denied | — |