OMAR USMAN
Subscriber on policy B02M000759
Claims
2
Attributed to this person
Charged
912.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
193.05
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 USMAN |
| Role on the policy | Subscriber |
| Policy | B02M000759 |
| Date of birth | 24 Feb 1976 |
| Plan | SILVER HMO |
| Covered from | 1 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 193.05 |
| Total | 193.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003171 | 21 Jul 2026 | 615.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003170 | 12 Nov 2025 | 297.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |