UMA WILSON
Dependent on policy B03M000342
Claims
3
Attributed to this person
Charged
1,013.00
Total submitted
Denied
751.00
3 denied claims
Patient responsibility
170.30
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 WILSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000342 |
| Date of birth | 29 Apr 1990 |
| Plan | SILVER HMO |
| Covered from | 6 Jun 2025 |
| Covered to | 20 Oct 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 170.30 |
| Total | 170.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001384 | 9 Dec 2025 | 193.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 193.00 |
| CLM0001383 | 29 Oct 2025 | 558.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 558.00 |
| CLM0001382 | 17 Jun 2025 | 262.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |