GRACE SMITH
Subscriber on policy B02M000146
Claims
1
Attributed to this person
Charged
367.00
Total submitted
Denied
120.73
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 | GRACE SMITH |
| Role on the policy | Subscriber |
| Policy | B02M000146 |
| Date of birth | 30 Jan 1966 |
| Plan | SILVER HMO |
| Covered from | 3 Jan 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 |
|---|---|---|---|---|---|
| CLM0000665 | 21 Jul 2025 | 367.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 120.73 |