OMAR SMITH
Dependent on policy B01M000288
Claims
3
Attributed to this person
Charged
1,772.00
Total submitted
Denied
1,404.11
3 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 | OMAR SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000288 |
| Date of birth | 9 Aug 1998 |
| Plan | PLATINUM PPO |
| Covered from | 20 Dec 2024 |
| Covered to | 18 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 |
|---|---|---|---|---|---|
| CLM0001256 | 7 May 2025 | 571.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 571.00 |
| CLM0001255 | 6 May 2025 | 542.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 542.00 |
| CLM0001254 | 15 Apr 2025 | 659.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 291.11 |