SOFIA SMITH
Subscriber on policy B09M000762
Claims
1
Attributed to this person
Charged
132.00
Total submitted
Denied
132.00
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 | SOFIA SMITH |
| Role on the policy | Subscriber |
| Policy | B09M000762 |
| Date of birth | 10 Oct 1972 |
| Plan | SILVER HMO |
| Covered from | 13 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003220 | 10 Jul 2026 | 132.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 132.00 |