MARCUS USMAN
Subscriber on policy B04M000663
Claims
2
Attributed to this person
Charged
1,463.00
Total submitted
Denied
791.00
1 denied claims
Patient responsibility
100.80
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 | MARCUS USMAN |
| Role on the policy | Subscriber |
| Policy | B04M000663 |
| Date of birth | 28 Jul 1980 |
| Plan | SILVER HMO |
| Covered from | 29 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 100.80 |
| Total | 100.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002889 | 21 Nov 2025 | 672.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002888 | 7 Mar 2025 | 791.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 791.00 |