GRACE SMITH
Subscriber on policy B07M000756
Claims
3
Attributed to this person
Charged
1,997.00
Total submitted
Denied
1,282.00
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 | GRACE SMITH |
| Role on the policy | Subscriber |
| Policy | B07M000756 |
| Date of birth | 22 Jul 1966 |
| Plan | BRONZE EPO |
| Covered from | 19 Oct 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 |
|---|---|---|---|---|---|
| CLM0003134 | 15 Dec 2025 | 715.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003135 | 14 Jun 2025 | 558.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 558.00 |
| CLM0003136 | 2 Nov 2024 | 724.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 724.00 |