BRIAN SMITH
Subscriber on policy B07M000579
Claims
2
Attributed to this person
Charged
732.00
Total submitted
Denied
307.00
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 | BRIAN SMITH |
| Role on the policy | Subscriber |
| Policy | B07M000579 |
| Date of birth | 25 Jul 1974 |
| Plan | SILVER HMO |
| Covered from | 23 Jun 2024 |
| Covered to | 18 Mar 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002449 | 20 Sep 2024 | 425.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002450 | 21 Jun 2024 | 307.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 307.00 |