UMA SMITH
Dependent on policy B08M000285
Claims
3
Attributed to this person
Charged
1,244.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
112.45
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 | UMA SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000285 |
| Date of birth | 2 Jul 1962 |
| Plan | BRONZE EPO |
| Covered from | 20 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 112.45 |
| Total | 112.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001303 | 18 Mar 2026 | 467.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001302 | 27 May 2025 | 604.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001304 | 1 Dec 2024 | 173.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |