KEVIN SMITH
Dependent on policy B10M000482
Claims
2
Attributed to this person
Charged
917.00
Total submitted
Denied
536.00
1 denied claims
Patient responsibility
76.20
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 | KEVIN SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000482 |
| Date of birth | 21 Mar 1989 |
| Plan | BRONZE EPO |
| Covered from | 22 Oct 2024 |
| Covered to | 11 Feb 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 76.20 |
| Total | 76.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002007 | 3 Apr 2025 | 536.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 536.00 |
| CLM0002006 | 8 Oct 2024 | 381.00 | MERIDIAN HEALTH PLAN | Not denied | — |