SOFIA SMITH
Subscriber on policy B10M000742
Claims
2
Attributed to this person
Charged
1,323.00
Total submitted
Denied
472.00
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 | SOFIA SMITH |
| Role on the policy | Subscriber |
| Policy | B10M000742 |
| Date of birth | 22 Sep 1986 |
| Plan | SILVER HMO |
| Covered from | 17 May 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0003115 | 16 Jun 2025 | 851.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003116 | 30 Apr 2024 | 472.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 472.00 |