BRIAN SMITH
Subscriber on policy B06M000261
Claims
3
Attributed to this person
Charged
2,154.00
Total submitted
Denied
1,280.00
3 denied claims
Patient responsibility
568.10
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 | BRIAN SMITH |
| Role on the policy | Subscriber |
| Policy | B06M000261 |
| Date of birth | 25 Mar 1990 |
| Plan | SILVER HMO |
| Covered from | 4 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 568.10 |
| Total | 568.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001236 | 3 Mar 2026 | 874.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |
| CLM0001237 | 8 Nov 2025 | 702.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 702.00 |
| CLM0001238 | 2 Oct 2025 | 578.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 578.00 |