BRIAN SMITH
Subscriber on policy B07M000533
Claims
2
Attributed to this person
Charged
1,191.00
Total submitted
Denied
576.00
1 denied claims
Patient responsibility
92.25
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 | BRIAN SMITH |
| Role on the policy | Subscriber |
| Policy | B07M000533 |
| Date of birth | 13 Oct 1957 |
| Plan | SILVER HMO |
| Covered from | 4 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 92.25 |
| Total | 92.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002272 | 7 Aug 2025 | 576.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 576.00 |
| CLM0002273 | 24 Oct 2024 | 615.00 | MERIDIAN HEALTH PLAN | Not denied | — |