UMA QUINN
Dependent on policy B05M000020
Claims
2
Attributed to this person
Charged
737.00
Total submitted
Denied
156.07
2 denied claims
Patient responsibility
201.50
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 QUINN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000020 |
| Date of birth | 21 Nov 2009 |
| Plan | BRONZE EPO |
| Covered from | 29 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 201.50 |
| Total | 201.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000094 | 25 Jun 2026 | 310.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0000095 | 7 Jan 2026 | 427.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 156.07 |