ZARA LOPEZ
Subscriber on policy B01M000313
Claims
1
Attributed to this person
Charged
544.00
Total submitted
Denied
544.00
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 | ZARA LOPEZ |
| Role on the policy | Subscriber |
| Policy | B01M000313 |
| Date of birth | 5 Sep 1968 |
| Plan | BRONZE EPO |
| Covered from | 3 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001392 | 3 Oct 2024 | 544.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 544.00 |