WENDY SMITH
Subscriber on policy B05M000000
Claims
3
Attributed to this person
Charged
1,626.00
Total submitted
Denied
876.00
2 denied claims
Patient responsibility
324.35
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 | WENDY SMITH |
| Role on the policy | Subscriber |
| Policy | B05M000000 |
| Date of birth | 23 Apr 1999 |
| Plan | BRONZE EPO |
| Covered from | 12 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 324.35 |
| Total | 324.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000002 | 16 Jun 2026 | 499.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0000003 | 27 Oct 2025 | 876.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 876.00 |
| CLM0000001 | 16 Sep 2025 | 251.00 | NORTHSTAR MUTUAL | Not denied | — |