IVAN SMITH
Dependent on policy B01M000478
Claims
1
Attributed to this person
Charged
262.00
Total submitted
Denied
262.00
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 | IVAN SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000478 |
| Date of birth | 17 Feb 2005 |
| Plan | SILVER HMO |
| Covered from | 6 Sep 2024 |
| Covered to | 19 Jan 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002133 | 7 Aug 2024 | 262.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 262.00 |