PRIYA IQBAL
Subscriber on policy B04M000131
Claims
3
Attributed to this person
Charged
1,796.00
Total submitted
Denied
548.00
2 denied claims
Patient responsibility
328.25
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 IQBAL |
| Role on the policy | Subscriber |
| Policy | B04M000131 |
| Date of birth | 19 Sep 2004 |
| Plan | SILVER HMO |
| Covered from | 3 Jun 2024 |
| Covered to | 14 Feb 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 328.25 |
| Total | 328.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000598 | 10 Apr 2025 | 548.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 548.00 |
| CLM0000599 | 14 Dec 2024 | 505.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000600 | 5 Oct 2024 | 743.00 | NORTHSTAR MUTUAL | Not denied | — |