GRACE SMITH
Subscriber on policy B07M000826
Claims
3
Attributed to this person
Charged
1,471.00
Total submitted
Denied
516.00
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 | GRACE SMITH |
| Role on the policy | Subscriber |
| Policy | B07M000826 |
| Date of birth | 26 Jun 1972 |
| Plan | SILVER HMO |
| Covered from | 7 Aug 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 |
|---|---|---|---|---|---|
| CLM0003384 | 6 Apr 2025 | 516.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 516.00 |
| CLM0003386 | 3 Feb 2025 | 368.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003385 | 24 Oct 2024 | 587.00 | MERIDIAN HEALTH PLAN | Not denied | — |