SOFIA SMITH
Dependent on policy B06M000680
Claims
3
Attributed to this person
Charged
952.00
Total submitted
Denied
952.00
3 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 | SOFIA SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000680 |
| Date of birth | 5 Feb 1957 |
| Plan | BRONZE EPO |
| Covered from | 22 Aug 2024 |
| Covered to | 23 Feb 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 |
|---|---|---|---|---|---|
| CLM0003024 | 5 Jan 2025 | 330.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 330.00 |
| CLM0003026 | 27 Oct 2024 | 245.00 | CASCADE CARE | CARC 18 · DUPLICATE | 245.00 |
| CLM0003025 | 25 Jul 2024 | 377.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 377.00 |