UMA LOPEZ
Subscriber on policy B01M000126
Claims
3
Attributed to this person
Charged
1,752.00
Total submitted
Denied
897.00
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 | UMA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B01M000126 |
| Date of birth | 15 Mar 1967 |
| Plan | BRONZE EPO |
| Covered from | 27 Jan 2024 |
| Covered to | 28 Oct 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000498 | 30 Nov 2024 | 408.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 408.00 |
| CLM0000496 | 14 Aug 2024 | 855.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000497 | 17 Apr 2024 | 489.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 489.00 |