GRACE QUINN
Subscriber on policy B03M000786
Claims
3
Attributed to this person
Charged
2,204.00
Total submitted
Denied
1,549.00
2 denied claims
Patient responsibility
98.25
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 | GRACE QUINN |
| Role on the policy | Subscriber |
| Policy | B03M000786 |
| Date of birth | 13 Jun 1968 |
| Plan | GOLD PPO |
| Covered from | 21 Jan 2024 |
| Covered to | 24 Mar 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 98.25 |
| Total | 98.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003343 | 12 May 2024 | 655.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003341 | 20 Feb 2024 | 793.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 793.00 |
| CLM0003342 | 14 Feb 2024 | 756.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 756.00 |