HENRY SMITH
Dependent on policy B03M000134
Claims
3
Attributed to this person
Charged
1,732.00
Total submitted
Denied
216.59
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 | HENRY SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000134 |
| Date of birth | 23 Oct 1995 |
| Plan | SILVER HMO |
| Covered from | 13 Dec 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 |
|---|---|---|---|---|---|
| CLM0000535 | 6 Jun 2026 | 697.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 216.59 |
| CLM0000536 | 14 Jan 2025 | 213.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000537 | 27 Dec 2024 | 822.00 | NORTHSTAR MUTUAL | Not denied | — |