ELENA SMITH
Dependent on policy B10M000569
Claims
2
Attributed to this person
Charged
883.00
Total submitted
Denied
135.08
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 | ELENA SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000569 |
| Date of birth | 29 Mar 1993 |
| Plan | PLATINUM PPO |
| Covered from | 12 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002358 | 19 Nov 2025 | 336.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 135.08 |
| CLM0002360 | 29 Jul 2025 | 547.00 | NORTHSTAR MUTUAL | Not denied | — |