OMAR SMITH
Subscriber on policy B10M000675
Claims
2
Attributed to this person
Charged
1,108.00
Total submitted
Denied
225.00
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 | OMAR SMITH |
| Role on the policy | Subscriber |
| Policy | B10M000675 |
| Date of birth | 16 Nov 1965 |
| Plan | SILVER HMO |
| Covered from | 14 Jan 2025 |
| Covered to | 30 Oct 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 |
|---|---|---|---|---|---|
| CLM0002801 | 5 Oct 2025 | 225.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 225.00 |
| CLM0002802 | 4 Jul 2025 | 883.00 | NORTHSTAR MUTUAL | Not denied | — |