IVAN SMITH
Dependent on policy B02M000695
Claims
2
Attributed to this person
Charged
937.00
Total submitted
Denied
937.00
2 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 | IVAN SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000695 |
| Date of birth | 30 Sep 2004 |
| Plan | GOLD PPO |
| Covered from | 2 Mar 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 |
|---|---|---|---|---|---|
| CLM0002930 | 30 Jul 2026 | 71.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 71.00 |
| CLM0002929 | 19 Feb 2025 | 866.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 866.00 |