PRIYA LOPEZ
Dependent on policy B05M000143
Claims
3
Attributed to this person
Charged
1,632.00
Total submitted
Denied
776.00
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 | PRIYA LOPEZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000143 |
| Date of birth | 26 Dec 1946 |
| Plan | GOLD PPO |
| Covered from | 21 Oct 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 |
|---|---|---|---|---|---|
| CLM0000589 | 6 Apr 2026 | 776.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 776.00 |
| CLM0000588 | 3 Jan 2026 | 437.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000587 | 4 Jun 2025 | 419.00 | NORTHSTAR MUTUAL | Not denied | — |