VICTOR SMITH
Dependent on policy B03M000003
Claims
1
Attributed to this person
Charged
768.00
Total submitted
Denied
768.00
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 | VICTOR SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000003 |
| Date of birth | 20 Apr 1952 |
| Plan | SILVER HMO |
| Covered from | 16 May 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 |
|---|---|---|---|---|---|
| CLM0000018 | 2 Jun 2024 | 768.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 768.00 |