CARLA SMITH
Dependent on policy B10M000509
Claims
3
Attributed to this person
Charged
2,096.00
Total submitted
Denied
1,318.00
2 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 | CARLA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000509 |
| Date of birth | 6 Feb 2006 |
| 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 |
|---|---|---|---|---|---|
| CLM0002096 | 9 May 2025 | 775.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 775.00 |
| CLM0002097 | 14 Apr 2025 | 543.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 543.00 |
| CLM0002095 | 29 Mar 2025 | 778.00 | NORTHSTAR MUTUAL | Not denied | — |