VICTOR MURPHY
Subscriber on policy B04M000254
Claims
2
Attributed to this person
Charged
1,263.00
Total submitted
Denied
883.00
1 denied claims
Patient responsibility
76.00
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 | VICTOR MURPHY |
| Role on the policy | Subscriber |
| Policy | B04M000254 |
| Date of birth | 14 Mar 1952 |
| Plan | GOLD PPO |
| Covered from | 11 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 76.00 |
| Total | 76.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001108 | 28 Dec 2025 | 380.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001109 | 9 Aug 2025 | 883.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 883.00 |