MARCUS LOPEZ
Dependent on policy B05M000417
Claims
3
Attributed to this person
Charged
1,456.00
Total submitted
Denied
1,331.40
3 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 | MARCUS LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000417 |
| Date of birth | 12 Apr 2017 |
| Plan | PLATINUM PPO |
| Covered from | 21 Jun 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0001759 | 14 Jun 2026 | 239.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 114.40 |
| CLM0001760 | 22 Sep 2025 | 581.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 581.00 |
| CLM0001761 | 16 Jul 2025 | 636.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 636.00 |