RAVI SMITH
Dependent on policy B07M000384
Claims
2
Attributed to this person
Charged
690.00
Total submitted
Denied
690.00
2 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 | RAVI SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000384 |
| Date of birth | 9 Jul 2008 |
| Plan | PLATINUM PPO |
| Covered from | 18 Apr 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 |
|---|---|---|---|---|---|
| CLM0001645 | 4 Jul 2025 | 397.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 397.00 |
| CLM0001644 | 22 Aug 2024 | 293.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 293.00 |