OMAR SMITH
Subscriber on policy B02M000207
Claims
2
Attributed to this person
Charged
931.00
Total submitted
Denied
99.21
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 | OMAR SMITH |
| Role on the policy | Subscriber |
| Policy | B02M000207 |
| Date of birth | 3 Jan 2003 |
| Plan | BRONZE EPO |
| Covered from | 16 Jun 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 |
|---|---|---|---|---|---|
| CLM0000911 | 13 Apr 2026 | 712.00 | CASCADE CARE | Not denied | — |
| CLM0000912 | 30 Dec 2025 | 219.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 99.21 |