PRIYA SMITH
Dependent on policy B03M000681
Claims
2
Attributed to this person
Charged
333.00
Total submitted
Denied
143.00
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 | PRIYA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000681 |
| Date of birth | 26 Nov 2002 |
| Plan | PLATINUM PPO |
| Covered from | 14 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 |
|---|---|---|---|---|---|
| CLM0002840 | 12 Feb 2026 | 143.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 143.00 |
| CLM0002841 | 8 Oct 2025 | 190.00 | NORTHSTAR MUTUAL | Not denied | — |