TOMAS SMITH
Dependent on policy B10M000211
Claims
2
Attributed to this person
Charged
784.00
Total submitted
Denied
74.00
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 | TOMAS SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000211 |
| Date of birth | 27 Jun 1990 |
| Plan | SILVER HMO |
| Covered from | 24 Apr 2025 |
| Covered to | 17 Jul 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 |
|---|---|---|---|---|---|
| CLM0000862 | 13 Sep 2025 | 74.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 74.00 |
| CLM0000861 | 5 Jun 2025 | 710.00 | CASCADE CARE | Not denied | — |