YUSUF SMITH
Dependent on policy B01M000828
Claims
1
Attributed to this person
Charged
175.00
Total submitted
Denied
175.00
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 | YUSUF SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000828 |
| Date of birth | 28 Feb 2011 |
| Plan | SILVER HMO |
| Covered from | 23 Mar 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 |
|---|---|---|---|---|---|
| CLM0003678 | 2 Mar 2024 | 175.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 175.00 |