TOMAS SMITH
Subscriber on policy B01M000051
Claims
1
Attributed to this person
Charged
900.00
Total submitted
Denied
337.16
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 | B01M000051 |
| Date of birth | 6 Aug 2002 |
| Plan | BRONZE EPO |
| Covered from | 1 Jul 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 |
|---|---|---|---|---|---|
| CLM0000204 | 24 Jul 2026 | 900.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 337.16 |