UMA GARCIA
Dependent on policy B03M000260
Claims
3
Attributed to this person
Charged
1,650.00
Total submitted
Denied
1,517.00
2 denied claims
Patient responsibility
19.95
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 | UMA GARCIA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000260 |
| Date of birth | 13 Dec 2006 |
| Plan | GOLD PPO |
| Covered from | 26 Mar 2024 |
| Covered to | 2 Aug 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 19.95 |
| Total | 19.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001050 | 6 Jul 2024 | 740.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 740.00 |
| CLM0001051 | 7 May 2024 | 133.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001049 | 6 Mar 2024 | 777.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 777.00 |