GRACE YAMADA
Dependent on policy B03M000717
Claims
2
Attributed to this person
Charged
853.00
Total submitted
Denied
546.00
1 denied claims
Patient responsibility
0.00
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 YAMADA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000717 |
| Date of birth | 1 Feb 2005 |
| Plan | SILVER HMO |
| Covered from | 19 Jan 2024 |
| Covered to | 15 Jun 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002995 | 2 Aug 2024 | 546.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 546.00 |
| CLM0002996 | 6 Mar 2024 | 307.00 | NORTHSTAR MUTUAL | Not denied | — |