RAVI SMITH
Dependent on policy B07M000504
Claims
2
Attributed to this person
Charged
674.00
Total submitted
Denied
436.00
1 denied claims
Patient responsibility
40.00
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 | RAVI SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000504 |
| Date of birth | 16 Jul 1993 |
| Plan | PLATINUM PPO |
| Covered from | 18 Mar 2025 |
| Covered to | 7 Jul 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 40.00 |
| Total | 40.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002158 | 23 Aug 2025 | 436.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 436.00 |
| CLM0002157 | 23 Jul 2025 | 238.00 | MERIDIAN HEALTH PLAN | Not denied | — |