PRIYA VARGAS
Dependent on policy B03M000192
Claims
3
Attributed to this person
Charged
1,891.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
178.75
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 | PRIYA VARGAS |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000192 |
| Date of birth | 14 Jan 1956 |
| Plan | SILVER HMO |
| Covered from | 9 Mar 2024 |
| Covered to | 10 Sep 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 178.75 |
| Total | 178.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000783 | 6 Sep 2024 | 765.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000784 | 6 Mar 2024 | 275.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0000785 | 13 Feb 2024 | 851.00 | NORTHSTAR MUTUAL | Not denied | — |