PRIYA SMITH
Subscriber on policy B01M000639
Claims
2
Attributed to this person
Charged
1,606.00
Total submitted
Denied
209.05
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 | PRIYA SMITH |
| Role on the policy | Subscriber |
| Policy | B01M000639 |
| Date of birth | 18 Jan 1990 |
| Plan | GOLD PPO |
| Covered from | 6 Feb 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 |
|---|---|---|---|---|---|
| CLM0002853 | 6 Sep 2025 | 824.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002852 | 13 Sep 2024 | 782.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 209.05 |