GRACE MURPHY
Subscriber on policy B05M000392
Claims
1
Attributed to this person
Charged
814.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
529.10
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 | GRACE MURPHY |
| Role on the policy | Subscriber |
| Policy | B05M000392 |
| Date of birth | 11 May 1973 |
| Plan | GOLD PPO |
| Covered from | 2 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 529.10 |
| Total | 529.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001678 | 24 Jan 2025 | 814.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |