YUSUF SMITH
Subscriber on policy B06M000526
Claims
2
Attributed to this person
Charged
962.00
Total submitted
Denied
157.77
1 denied claims
Patient responsibility
43.05
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 | YUSUF SMITH |
| Role on the policy | Subscriber |
| Policy | B06M000526 |
| Date of birth | 21 Mar 2004 |
| Plan | SILVER HMO |
| Covered from | 24 Apr 2024 |
| Covered to | 27 Aug 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 43.05 |
| Total | 43.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002345 | 6 Aug 2024 | 675.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 157.77 |
| CLM0002344 | 7 Apr 2024 | 287.00 | NORTHSTAR MUTUAL | Not denied | — |