BRIAN ANDERSON
Subscriber on policy B03M000312
Claims
1
Attributed to this person
Charged
76.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
49.40
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 | BRIAN ANDERSON |
| Role on the policy | Subscriber |
| Policy | B03M000312 |
| Date of birth | 25 Apr 1986 |
| Plan | BRONZE EPO |
| Covered from | 16 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 49.40 |
| Total | 49.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001250 | 28 Mar 2025 | 76.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |