BRIAN SMITH
Dependent on policy B01M000288
Claims
2
Attributed to this person
Charged
274.00
Total submitted
Denied
86.00
1 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 | BRIAN SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000288 |
| Date of birth | 28 Mar 2021 |
| 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 |
|---|---|---|---|---|---|
| CLM0001260 | 26 Jan 2025 | 188.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001261 | 9 Jan 2025 | 86.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 86.00 |