YUSUF SMITH
Subscriber on policy B06M000016
Claims
3
Attributed to this person
Charged
2,068.00
Total submitted
Denied
633.00
2 denied claims
Patient responsibility
582.40
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 | YUSUF SMITH |
| Role on the policy | Subscriber |
| Policy | B06M000016 |
| Date of birth | 23 Jul 1984 |
| Plan | PLATINUM PPO |
| Covered from | 15 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 582.40 |
| Total | 582.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000089 | 28 Sep 2025 | 896.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000091 | 31 Aug 2025 | 539.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000090 | 8 Aug 2025 | 633.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 633.00 |