GRACE SMITH
Subscriber on policy B05M000133
Claims
2
Attributed to this person
Charged
208.00
Total submitted
Denied
130.28
2 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 | GRACE SMITH |
| Role on the policy | Subscriber |
| Policy | B05M000133 |
| Date of birth | 6 Jun 2004 |
| Plan | SILVER HMO |
| Covered from | 16 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 |
|---|---|---|---|---|---|
| CLM0000550 | 10 Jan 2026 | 91.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 13.28 |
| CLM0000551 | 28 Mar 2025 | 117.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 117.00 |