CARLA SMITH
Subscriber on policy B02M000656
Claims
2
Attributed to this person
Charged
1,016.00
Total submitted
Denied
196.06
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 | CARLA SMITH |
| Role on the policy | Subscriber |
| Policy | B02M000656 |
| Date of birth | 30 Dec 1964 |
| Plan | GOLD PPO |
| Covered from | 27 May 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0002767 | 23 Aug 2025 | 617.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002768 | 30 Jul 2025 | 399.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 196.06 |