SOFIA SMITH
Dependent on policy B06M000798
Claims
2
Attributed to this person
Charged
606.00
Total submitted
Denied
124.12
2 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 | SOFIA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000798 |
| Date of birth | 29 Apr 2009 |
| Plan | SILVER HMO |
| Covered from | 9 Dec 2024 |
| Covered to | 5 Sep 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003508 | 27 Feb 2025 | 397.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 79.98 |
| CLM0003509 | 17 Feb 2025 | 209.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 44.14 |