TOMAS SMITH
Subscriber on policy B05M000008
Claims
3
Attributed to this person
Charged
1,759.00
Total submitted
Denied
249.12
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 | B05M000008 |
| Date of birth | 24 Feb 1960 |
| Plan | BRONZE EPO |
| Covered from | 18 Feb 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 |
|---|---|---|---|---|---|
| CLM0000030 | 13 Mar 2026 | 715.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 148.25 |
| CLM0000029 | 19 May 2025 | 223.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 100.87 |
| CLM0000028 | 9 Apr 2025 | 821.00 | NORTHSTAR MUTUAL | Not denied | — |