KEVIN SMITH
Subscriber on policy B03M000392
Claims
2
Attributed to this person
Charged
1,507.00
Total submitted
Denied
1,507.00
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 | KEVIN SMITH |
| Role on the policy | Subscriber |
| Policy | B03M000392 |
| Date of birth | 22 Sep 1972 |
| Plan | BRONZE EPO |
| Covered from | 8 Nov 2024 |
| Covered to | 6 Feb 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001588 | 27 Jan 2025 | 684.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 684.00 |
| CLM0001587 | 22 Oct 2024 | 823.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 823.00 |