BRIAN USMAN
Subscriber on policy B03M000875
Claims
2
Attributed to this person
Charged
785.00
Total submitted
Denied
358.00
1 denied claims
Patient responsibility
64.05
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 USMAN |
| Role on the policy | Subscriber |
| Policy | B03M000875 |
| Date of birth | 21 Nov 1993 |
| Plan | BRONZE EPO |
| Covered from | 11 Oct 2024 |
| Covered to | 2 Jan 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 64.05 |
| Total | 64.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003796 | 16 Jan 2025 | 358.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 358.00 |
| CLM0003797 | 29 Nov 2024 | 427.00 | NORTHSTAR MUTUAL | Not denied | — |