OMAR SMITH
Subscriber on policy B10M000312
Claims
3
Attributed to this person
Charged
1,244.00
Total submitted
Denied
1,022.00
2 denied claims
Patient responsibility
44.40
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 | B10M000312 |
| Date of birth | 16 May 1989 |
| Plan | BRONZE EPO |
| Covered from | 21 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 44.40 |
| Total | 44.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001313 | 30 Jun 2026 | 222.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001314 | 8 Apr 2026 | 427.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 427.00 |
| CLM0001312 | 23 Oct 2025 | 595.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 595.00 |