OMAR SMITH
Subscriber on policy B09M000878
Claims
1
Attributed to this person
Charged
538.00
Total submitted
Denied
538.00
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 | OMAR SMITH |
| Role on the policy | Subscriber |
| Policy | B09M000878 |
| Date of birth | 10 Aug 1991 |
| Plan | GOLD PPO |
| Covered from | 20 Jul 2024 |
| Covered to | 29 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 |
|---|---|---|---|---|---|
| CLM0003733 | 24 Jun 2024 | 538.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 538.00 |