GRACE SMITH
Dependent on policy B01M000503
Claims
3
Attributed to this person
Charged
1,386.00
Total submitted
Denied
44.75
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 | Dependent · relationship 01 |
| Policy | B01M000503 |
| Date of birth | 15 Sep 1970 |
| Plan | SILVER HMO |
| Covered from | 23 Mar 2025 |
| Covered to | 26 Nov 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 |
|---|---|---|---|---|---|
| CLM0002257 | 1 Sep 2025 | 217.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 44.75 |
| CLM0002259 | 4 Aug 2025 | 851.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002258 | 22 Apr 2025 | 318.00 | MERIDIAN HEALTH PLAN | Not denied | — |