SOFIA SMITH
Dependent on policy B05M000435
Claims
2
Attributed to this person
Charged
948.00
Total submitted
Denied
629.00
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 | SOFIA SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000435 |
| Date of birth | 9 Dec 1958 |
| Plan | PLATINUM PPO |
| Covered from | 24 Aug 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 |
|---|---|---|---|---|---|
| CLM0001835 | 9 Mar 2025 | 629.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 629.00 |
| CLM0001834 | 3 Aug 2024 | 319.00 | NORTHSTAR MUTUAL | Not denied | — |