DAVID SMITH
Dependent on policy B02M000456
Claims
1
Attributed to this person
Charged
163.00
Total submitted
Denied
163.00
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 | DAVID SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000456 |
| Date of birth | 28 Jun 2010 |
| Plan | BRONZE EPO |
| Covered from | 7 Sep 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 |
|---|---|---|---|---|---|
| CLM0001949 | 9 Sep 2024 | 163.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 163.00 |