UMA REYES
Dependent on policy B04M000360
Claims
2
Attributed to this person
Charged
800.00
Total submitted
Denied
385.00
1 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 | UMA REYES |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000360 |
| Date of birth | 7 Nov 2016 |
| Plan | SILVER HMO |
| Covered from | 15 Aug 2024 |
| Covered to | 16 Jan 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 |
|---|---|---|---|---|---|
| CLM0001544 | 29 Sep 2024 | 385.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 385.00 |
| CLM0001543 | 16 Sep 2024 | 415.00 | NORTHSTAR MUTUAL | Not denied | — |