ZARA SMITH
Subscriber on policy B09M000306
Claims
1
Attributed to this person
Charged
893.00
Total submitted
Denied
893.00
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 | ZARA SMITH |
| Role on the policy | Subscriber |
| Policy | B09M000306 |
| Date of birth | 30 Dec 1965 |
| Plan | BRONZE EPO |
| Covered from | 1 Jul 2024 |
| Covered to | 28 Sep 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 |
|---|---|---|---|---|---|
| CLM0001258 | 23 Sep 2024 | 893.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 893.00 |