YUSUF SMITH
Dependent on policy B08M000193
Claims
3
Attributed to this person
Charged
1,766.00
Total submitted
Denied
700.00
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 | YUSUF SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000193 |
| Date of birth | 24 Jan 2009 |
| Plan | SILVER HMO |
| Covered from | 11 Feb 2024 |
| Covered to | 6 Jul 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000862 | 10 Aug 2024 | 700.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 700.00 |
| CLM0000864 | 23 Mar 2024 | 829.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000863 | 18 Feb 2024 | 237.00 | NORTHSTAR MUTUAL | Not denied | — |