RAVI SMITH
Subscriber on policy B03M000288
Claims
1
Attributed to this person
Charged
239.00
Total submitted
Denied
239.00
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 | RAVI SMITH |
| Role on the policy | Subscriber |
| Policy | B03M000288 |
| Date of birth | 11 Aug 1985 |
| Plan | BRONZE EPO |
| Covered from | 26 May 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 |
|---|---|---|---|---|---|
| CLM0001137 | 18 Sep 2025 | 239.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 239.00 |