DAVID SMITH
Subscriber on policy B03M000704
Claims
1
Attributed to this person
Charged
696.00
Total submitted
Denied
696.00
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 | DAVID SMITH |
| Role on the policy | Subscriber |
| Policy | B03M000704 |
| Date of birth | 2 Sep 1991 |
| Plan | SILVER HMO |
| Covered from | 10 Sep 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0002927 | 27 Jun 2025 | 696.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 696.00 |