CARLA SMITH
Dependent on policy B06M000365
Claims
3
Attributed to this person
Charged
1,488.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
466.70
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 | CARLA SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000365 |
| Date of birth | 24 Jan 1980 |
| Plan | SILVER HMO |
| Covered from | 6 Jul 2024 |
| Covered to | 11 Apr 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 466.70 |
| Total | 466.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001662 | 26 Mar 2025 | 204.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001664 | 21 Mar 2025 | 718.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0001663 | 24 Jul 2024 | 566.00 | NORTHSTAR MUTUAL | Not denied | — |