LEILA SMITH
Subscriber on policy B02M000062
Claims
1
Attributed to this person
Charged
729.00
Total submitted
Denied
729.00
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 | LEILA SMITH |
| Role on the policy | Subscriber |
| Policy | B02M000062 |
| Date of birth | 17 Apr 1979 |
| Plan | BRONZE EPO |
| Covered from | 13 Apr 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 |
|---|---|---|---|---|---|
| CLM0000289 | 26 Apr 2024 | 729.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 729.00 |