TOMAS SMITH
Subscriber on policy B03M000050
Claims
1
Attributed to this person
Charged
99.00
Total submitted
Denied
99.00
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 | TOMAS SMITH |
| Role on the policy | Subscriber |
| Policy | B03M000050 |
| Date of birth | 26 Apr 1977 |
| Plan | SILVER HMO |
| Covered from | 29 Feb 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 |
|---|---|---|---|---|---|
| CLM0000217 | 6 Sep 2025 | 99.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 99.00 |