LEILA SMITH
Dependent on policy B06M000365
Claims
3
Attributed to this person
Charged
1,542.00
Total submitted
Denied
397.52
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 | LEILA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000365 |
| Date of birth | 26 Mar 2019 |
| Plan | SILVER HMO |
| Covered from | 6 Jul 2024 |
| Covered to | 11 Apr 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 |
|---|---|---|---|---|---|
| CLM0001666 | 21 Jan 2025 | 184.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 184.00 |
| CLM0001665 | 25 Nov 2024 | 759.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001667 | 17 Nov 2024 | 599.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 213.52 |