RAVI SMITH
Subscriber on policy B08M000770
Claims
1
Attributed to this person
Charged
229.00
Total submitted
Denied
102.75
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 | RAVI SMITH |
| Role on the policy | Subscriber |
| Policy | B08M000770 |
| Date of birth | 15 Feb 1990 |
| Plan | BRONZE EPO |
| Covered from | 1 Jan 2025 |
| Covered to | 18 Jul 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003446 | 6 May 2025 | 229.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 102.75 |