BRIAN QUINN
Dependent on policy B01M000493
Claims
3
Attributed to this person
Charged
1,229.00
Total submitted
Denied
748.00
2 denied claims
Patient responsibility
189.15
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 QUINN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000493 |
| Date of birth | 4 Dec 1970 |
| Plan | SILVER HMO |
| Covered from | 16 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 152.10 |
| CARC 1 · Deductible | 1 | 37.05 |
| Total | 189.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002200 | 12 Oct 2025 | 748.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 748.00 |
| CLM0002201 | 2 Oct 2025 | 247.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002202 | 5 Aug 2025 | 234.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |