DAVID SMITH
Subscriber on policy B01M000088
Claims
2
Attributed to this person
Charged
939.00
Total submitted
Denied
398.00
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 | DAVID SMITH |
| Role on the policy | Subscriber |
| Policy | B01M000088 |
| Date of birth | 5 Sep 1955 |
| Plan | PLATINUM PPO |
| Covered from | 26 Apr 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 |
|---|---|---|---|---|---|
| CLM0000350 | 1 Aug 2026 | 398.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 398.00 |
| CLM0000351 | 27 Mar 2026 | 541.00 | NORTHSTAR MUTUAL | Not denied | — |