YUSUF SMITH
Dependent on policy B02M000010
Claims
3
Attributed to this person
Charged
707.00
Total submitted
Denied
100.39
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 | YUSUF SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000010 |
| Date of birth | 22 Nov 2023 |
| Plan | SILVER HMO |
| Covered from | 3 Jan 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 |
|---|---|---|---|---|---|
| CLM0000072 | 4 May 2026 | 208.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 100.39 |
| CLM0000071 | 20 Oct 2025 | 218.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000073 | 3 Jan 2025 | 281.00 | NORTHSTAR MUTUAL | Not denied | — |