ELENA SMITH
Subscriber on policy B01M000430
Claims
1
Attributed to this person
Charged
448.00
Total submitted
Denied
448.00
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 | Subscriber |
| Policy | B01M000430 |
| Date of birth | 6 Oct 1979 |
| Plan | BRONZE EPO |
| Covered from | 5 Jun 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 |
|---|---|---|---|---|---|
| CLM0001888 | 8 May 2025 | 448.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 448.00 |