HENRY SMITH
Subscriber on policy B01M000117
Claims
2
Attributed to this person
Charged
579.00
Total submitted
Denied
579.00
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 | HENRY SMITH |
| Role on the policy | Subscriber |
| Policy | B01M000117 |
| Date of birth | 22 Jan 2004 |
| Plan | GOLD PPO |
| Covered from | 19 Jun 2024 |
| Covered to | 27 Oct 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000455 | 10 Nov 2024 | 215.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 215.00 |
| CLM0000456 | 6 Nov 2024 | 364.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 364.00 |