KEVIN REYES
Subscriber on policy B04M000360
Claims
3
Attributed to this person
Charged
2,234.00
Total submitted
Denied
1,128.81
2 denied claims
Patient responsibility
144.20
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 | KEVIN REYES |
| Role on the policy | Subscriber |
| Policy | B04M000360 |
| Date of birth | 1 Oct 1998 |
| Plan | SILVER HMO |
| Covered from | 15 Aug 2024 |
| Covered to | 16 Jan 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 144.20 |
| Total | 144.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001538 | 27 Feb 2025 | 721.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001540 | 8 Nov 2024 | 615.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 230.81 |
| CLM0001539 | 27 Aug 2024 | 898.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 898.00 |