UMA SMITH
Dependent on policy B05M000482
Claims
2
Attributed to this person
Charged
1,625.00
Total submitted
Denied
317.19
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 | UMA SMITH |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000482 |
| Date of birth | 17 Jul 1985 |
| Plan | GOLD PPO |
| Covered from | 6 Apr 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0002033 | 1 Mar 2026 | 767.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 317.19 |
| CLM0002034 | 23 Aug 2025 | 858.00 | NORTHSTAR MUTUAL | Not denied | — |