ZARA USMAN
Dependent on policy B04M000793
Claims
3
Attributed to this person
Charged
1,551.00
Total submitted
Denied
1,551.00
3 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 | ZARA USMAN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000793 |
| Date of birth | 2 Oct 1967 |
| Plan | PLATINUM PPO |
| Covered from | 6 Feb 2024 |
| Covered to | 6 Apr 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 |
|---|---|---|---|---|---|
| CLM0003464 | 29 Feb 2024 | 650.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 650.00 |
| CLM0003462 | 2 Feb 2024 | 799.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 799.00 |
| CLM0003463 | 15 Jan 2024 | 102.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 102.00 |