FIONA SMITH
Subscriber on policy B05M000527
Claims
2
Attributed to this person
Charged
359.00
Total submitted
Denied
236.00
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 | FIONA SMITH |
| Role on the policy | Subscriber |
| Policy | B05M000527 |
| Date of birth | 11 Aug 1962 |
| Plan | PLATINUM PPO |
| Covered from | 6 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 |
|---|---|---|---|---|---|
| CLM0002253 | 7 Dec 2024 | 123.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002254 | 20 Oct 2024 | 236.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 236.00 |