GRACE HUGHES
Dependent on policy B02M000156
Claims
3
Attributed to this person
Charged
1,611.00
Total submitted
Denied
791.00
3 denied claims
Patient responsibility
533.00
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 | GRACE HUGHES |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000156 |
| Date of birth | 15 Jan 2001 |
| Plan | SILVER HMO |
| Covered from | 19 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 533.00 |
| Total | 533.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000707 | 4 Jan 2026 | 286.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 286.00 |
| CLM0000705 | 16 May 2024 | 505.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 505.00 |
| CLM0000706 | 9 May 2024 | 820.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |