ELENA REYES
Dependent on policy B04M000279
Claims
3
Attributed to this person
Charged
1,347.00
Total submitted
Denied
1,131.00
2 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 REYES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000279 |
| Date of birth | 15 May 1987 |
| Plan | BRONZE EPO |
| Covered from | 18 Mar 2024 |
| Covered to | 30 Jul 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 |
|---|---|---|---|---|---|
| CLM0001202 | 4 Aug 2024 | 253.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 253.00 |
| CLM0001204 | 30 May 2024 | 878.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 878.00 |
| CLM0001203 | 26 May 2024 | 216.00 | NORTHSTAR MUTUAL | Not denied | — |