IVAN SMITH
Subscriber on policy B03M000553
Claims
2
Attributed to this person
Charged
913.00
Total submitted
Denied
913.00
2 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 | Subscriber |
| Policy | B03M000553 |
| Date of birth | 27 May 1991 |
| Plan | GOLD PPO |
| Covered from | 3 May 2024 |
| Covered to | 4 Aug 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002268 | 24 Jul 2024 | 389.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 389.00 |
| CLM0002269 | 14 Jun 2024 | 524.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 524.00 |