UMA SMITH
Dependent on policy B03M000091
Claims
3
Attributed to this person
Charged
1,228.00
Total submitted
Denied
1,065.00
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 | UMA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000091 |
| Date of birth | 18 Apr 2018 |
| Plan | BRONZE EPO |
| Covered from | 15 Feb 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 |
|---|---|---|---|---|---|
| CLM0000382 | 4 Mar 2026 | 591.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 591.00 |
| CLM0000381 | 13 Nov 2024 | 163.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000380 | 13 Feb 2024 | 474.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 474.00 |