PRIYA USMAN
Subscriber on policy B04M000128
Claims
3
Attributed to this person
Charged
1,337.00
Total submitted
Denied
307.00
2 denied claims
Patient responsibility
304.85
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 | PRIYA USMAN |
| Role on the policy | Subscriber |
| Policy | B04M000128 |
| Date of birth | 9 May 1997 |
| Plan | PLATINUM PPO |
| Covered from | 6 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 304.85 |
| Total | 304.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000590 | 14 Jul 2026 | 561.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000591 | 27 Oct 2025 | 307.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 307.00 |
| CLM0000589 | 9 Mar 2025 | 469.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |