BRIAN SMITH
Dependent on policy B10M000509
Claims
3
Attributed to this person
Charged
543.00
Total submitted
Denied
245.00
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 | BRIAN SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000509 |
| Date of birth | 20 Jul 2009 |
| Plan | PLATINUM PPO |
| Covered from | 9 Mar 2025 |
| Covered to | 16 May 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002092 | 7 May 2025 | 217.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002094 | 7 May 2025 | 81.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002093 | 18 Mar 2025 | 245.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 245.00 |