TOMAS SMITH
Subscriber on policy B05M000812
Claims
2
Attributed to this person
Charged
855.00
Total submitted
Denied
855.00
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 | TOMAS SMITH |
| Role on the policy | Subscriber |
| Policy | B05M000812 |
| Date of birth | 8 Sep 1968 |
| Plan | SILVER HMO |
| Covered from | 17 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 |
|---|---|---|---|---|---|
| CLM0003449 | 4 Nov 2025 | 676.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 676.00 |
| CLM0003448 | 17 Jul 2025 | 179.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 179.00 |