OMAR SMITH
Subscriber on policy B05M000119
Claims
1
Attributed to this person
Charged
85.00
Total submitted
Denied
85.00
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 | OMAR SMITH |
| Role on the policy | Subscriber |
| Policy | B05M000119 |
| Date of birth | 16 Jun 1971 |
| Plan | BRONZE EPO |
| Covered from | 12 Jan 2025 |
| Covered to | 30 Sep 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000495 | 16 Aug 2025 | 85.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 85.00 |