ELENA SMITH
Dependent on policy B05M000745
Claims
2
Attributed to this person
Charged
1,631.00
Total submitted
Denied
876.00
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 | ELENA SMITH |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000745 |
| Date of birth | 27 Jul 1995 |
| Plan | BRONZE EPO |
| Covered from | 9 Feb 2024 |
| Covered to | 1 Jul 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003179 | 6 May 2024 | 876.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 876.00 |
| CLM0003180 | 8 Apr 2024 | 755.00 | NORTHSTAR MUTUAL | Not denied | — |