GRACE SMITH
Dependent on policy B08M000155
Claims
3
Attributed to this person
Charged
669.00
Total submitted
Denied
343.00
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 | Dependent · relationship 01 |
| Policy | B08M000155 |
| Date of birth | 14 Oct 1992 |
| Plan | PLATINUM PPO |
| Covered from | 28 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 |
|---|---|---|---|---|---|
| CLM0000713 | 13 Mar 2026 | 173.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 173.00 |
| CLM0000715 | 25 Dec 2025 | 326.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000714 | 4 Dec 2024 | 170.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 170.00 |