MARCUS SMITH
Dependent on policy B08M000373
Claims
2
Attributed to this person
Charged
986.00
Total submitted
Denied
736.00
1 denied claims
Patient responsibility
50.00
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 | MARCUS SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B08M000373 |
| Date of birth | 8 Feb 1960 |
| Plan | SILVER HMO |
| Covered from | 7 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001702 | 20 Apr 2026 | 736.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 736.00 |
| CLM0001703 | 19 May 2025 | 250.00 | NORTHSTAR MUTUAL | Not denied | — |