TOMAS KUMAR
Subscriber on policy B04M000340
Claims
2
Attributed to this person
Charged
375.00
Total submitted
Denied
375.00
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 | TOMAS KUMAR |
| Role on the policy | Subscriber |
| Policy | B04M000340 |
| Date of birth | 11 Mar 2001 |
| Plan | GOLD PPO |
| Covered from | 9 Dec 2024 |
| Covered to | 25 Mar 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001472 | 11 Mar 2025 | 204.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 204.00 |
| CLM0001473 | 16 Jan 2025 | 171.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 171.00 |