CARLA SMITH
Subscriber on policy B04M000600
Claims
2
Attributed to this person
Charged
798.00
Total submitted
Denied
489.00
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 | CARLA SMITH |
| Role on the policy | Subscriber |
| Policy | B04M000600 |
| Date of birth | 21 Feb 1986 |
| Plan | BRONZE EPO |
| Covered from | 29 Jan 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 |
|---|---|---|---|---|---|
| CLM0002630 | 7 Jul 2025 | 489.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 489.00 |
| CLM0002631 | 17 Apr 2024 | 309.00 | NORTHSTAR MUTUAL | Not denied | — |