CARLA SMITH
Dependent on policy B02M000062
Claims
3
Attributed to this person
Charged
1,889.00
Total submitted
Denied
350.00
1 denied claims
Patient responsibility
133.35
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 | CARLA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000062 |
| Date of birth | 19 Oct 2013 |
| Plan | BRONZE EPO |
| Covered from | 13 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 133.35 |
| Total | 133.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000294 | 14 Jul 2026 | 350.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 350.00 |
| CLM0000292 | 20 Apr 2026 | 889.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000293 | 31 Jan 2026 | 650.00 | NORTHSTAR MUTUAL | Not denied | — |