BRIAN SMITH
Subscriber on policy B06M000489
Claims
3
Attributed to this person
Charged
1,145.00
Total submitted
Denied
951.00
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 | BRIAN SMITH |
| Role on the policy | Subscriber |
| Policy | B06M000489 |
| Date of birth | 11 Nov 1971 |
| Plan | BRONZE EPO |
| Covered from | 24 Feb 2024 |
| Covered to | 24 Oct 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002199 | 22 Oct 2024 | 430.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 430.00 |
| CLM0002200 | 23 Jun 2024 | 521.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 521.00 |
| CLM0002201 | 26 May 2024 | 194.00 | MERIDIAN HEALTH PLAN | Not denied | — |