BRIAN SMITH
Dependent on policy B07M000756
Claims
2
Attributed to this person
Charged
1,013.00
Total submitted
Denied
712.00
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 | Dependent · relationship 01 |
| Policy | B07M000756 |
| Date of birth | 25 Apr 1961 |
| 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 |
|---|---|---|---|---|---|
| CLM0003138 | 19 Apr 2025 | 712.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 712.00 |
| CLM0003137 | 25 Feb 2025 | 301.00 | NORTHSTAR MUTUAL | Not denied | — |