BRIAN REYES
Subscriber on policy B05M000087
Claims
2
Attributed to this person
Charged
1,396.00
Total submitted
Denied
884.00
2 denied claims
Patient responsibility
332.80
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 | BRIAN REYES |
| Role on the policy | Subscriber |
| Policy | B05M000087 |
| Date of birth | 21 Nov 1969 |
| Plan | GOLD PPO |
| Covered from | 8 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 332.80 |
| Total | 332.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000390 | 4 Jun 2026 | 512.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0000391 | 26 May 2024 | 884.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 884.00 |