BRIAN SMITH
Dependent on policy B05M000482
Claims
3
Attributed to this person
Charged
1,190.00
Total submitted
Denied
188.00
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 | B05M000482 |
| Date of birth | 25 Nov 1978 |
| 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 |
|---|---|---|---|---|---|
| CLM0002036 | 22 Jun 2026 | 188.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 188.00 |
| CLM0002035 | 29 Jul 2025 | 431.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002037 | 11 Jul 2025 | 571.00 | NORTHSTAR MUTUAL | Not denied | — |