RAVI SMITH
Subscriber on policy B08M000829
Claims
3
Attributed to this person
Charged
1,721.00
Total submitted
Denied
754.00
1 denied claims
Patient responsibility
15.00
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 | B08M000829 |
| Date of birth | 1 Aug 1976 |
| Plan | PLATINUM PPO |
| Covered from | 23 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 15.00 |
| Total | 15.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003701 | 13 Jul 2025 | 572.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003700 | 3 Apr 2024 | 395.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003699 | 27 Feb 2024 | 754.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 754.00 |