HENRY KUMAR
Subscriber on policy B04M000350
Claims
2
Attributed to this person
Charged
1,158.00
Total submitted
Denied
762.00
1 denied claims
Patient responsibility
59.40
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 | HENRY KUMAR |
| Role on the policy | Subscriber |
| Policy | B04M000350 |
| Date of birth | 5 Nov 1959 |
| Plan | SILVER HMO |
| Covered from | 12 Apr 2024 |
| Covered to | 4 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 59.40 |
| Total | 59.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001501 | 9 Dec 2024 | 762.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 762.00 |
| CLM0001500 | 9 Jul 2024 | 396.00 | NORTHSTAR MUTUAL | Not denied | — |