IVAN SMITH
Dependent on policy B06M000104
Claims
2
Attributed to this person
Charged
798.00
Total submitted
Denied
370.00
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 | IVAN SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000104 |
| Date of birth | 25 Aug 1994 |
| Plan | PLATINUM PPO |
| Covered from | 3 Jun 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 |
|---|---|---|---|---|---|
| CLM0000521 | 28 Aug 2025 | 370.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 370.00 |
| CLM0000522 | 7 Aug 2025 | 428.00 | NORTHSTAR MUTUAL | Not denied | — |