ELENA USMAN
Subscriber on policy B04M000070
Claims
2
Attributed to this person
Charged
1,070.00
Total submitted
Denied
412.00
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 | ELENA USMAN |
| Role on the policy | Subscriber |
| Policy | B04M000070 |
| Date of birth | 28 Oct 1956 |
| Plan | SILVER HMO |
| Covered from | 23 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000319 | 7 Mar 2026 | 412.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 412.00 |
| CLM0000320 | 25 Sep 2024 | 658.00 | NORTHSTAR MUTUAL | Not denied | — |