TOMAS SMITH
Subscriber on policy B09M000327
Claims
1
Attributed to this person
Charged
899.00
Total submitted
Denied
251.49
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 | TOMAS SMITH |
| Role on the policy | Subscriber |
| Policy | B09M000327 |
| Date of birth | 9 Nov 1990 |
| Plan | PLATINUM PPO |
| Covered from | 24 Jun 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 |
|---|---|---|---|---|---|
| CLM0001360 | 29 Dec 2025 | 899.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 251.49 |