PRIYA SMITH
Dependent on policy B04M000548
Claims
3
Attributed to this person
Charged
1,170.00
Total submitted
Denied
175.00
2 denied claims
Patient responsibility
225.55
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 | B04M000548 |
| Date of birth | 30 Mar 2022 |
| Plan | SILVER HMO |
| Covered from | 19 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 225.55 |
| Total | 225.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002421 | 14 Aug 2026 | 648.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002420 | 29 Nov 2025 | 175.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 175.00 |
| CLM0002422 | 2 Nov 2025 | 347.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |