GRACE SMITH
Dependent on policy B03M000846
Claims
2
Attributed to this person
Charged
1,124.00
Total submitted
Denied
1,124.00
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 | GRACE SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000846 |
| Date of birth | 22 Sep 1998 |
| Plan | PLATINUM PPO |
| Covered from | 18 May 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0003667 | 28 Jun 2025 | 290.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 290.00 |
| CLM0003666 | 21 Apr 2025 | 834.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 834.00 |