IVAN SMITH
Dependent on policy B09M000283
Claims
2
Attributed to this person
Charged
1,231.00
Total submitted
Denied
403.00
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 | IVAN SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000283 |
| Date of birth | 3 Jun 2001 |
| Plan | PLATINUM PPO |
| Covered from | 4 Feb 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 |
|---|---|---|---|---|---|
| CLM0001167 | 25 Dec 2025 | 828.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001168 | 25 Mar 2025 | 403.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 403.00 |