SOFIA SMITH
Subscriber on policy B04M000736
Claims
3
Attributed to this person
Charged
1,625.00
Total submitted
Denied
1,389.00
2 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 | SOFIA SMITH |
| Role on the policy | Subscriber |
| Policy | B04M000736 |
| Date of birth | 16 Sep 1985 |
| Plan | BRONZE EPO |
| Covered from | 27 Oct 2024 |
| Covered to | 20 Apr 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003223 | 1 May 2025 | 777.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 777.00 |
| CLM0003222 | 26 Jan 2025 | 612.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 612.00 |
| CLM0003221 | 16 Oct 2024 | 236.00 | NORTHSTAR MUTUAL | Not denied | — |