Policy B04M000865
5 people enrolled on this policy.
People
5
On this policy
Claims attributed
12
To a named person
Policy-level
0
Not attributed to a person
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.
People on this policy
| Name | Role | Born | Claims | Denials | Denied | Patient responsibility (835) |
|---|---|---|---|---|---|---|
| JULIA SMITH | Subscriber | 19 Oct 1955 | 3 | 2 | 1,063.00 | 0.00 |
| MARCUS SMITH | Dependent · 01 | 15 Jun 1955 | 2 | 1 | 648.00 | 0.00 |
| LEILA SMITH | Dependent · 19 | 29 Jan 1990 | 1 | 0 | 0.00 | 57.00 |
| NADIA SMITH | Dependent · 19 | 29 Oct 1997 | 3 | 1 | 342.00 | 0.00 |
| GRACE SMITH | Dependent · 19 | 11 Sep 1998 | 3 | 1 | 479.00 | 0.00 |
Policy-level claims
Every claim on this policy is attributed to a named person.
Claims are attributed to a person from the patient loop of the 837P — name, date of birth and relationship within the policy — because the transaction carries no patient identifier. A claim that matches nobody, or more than one person, stays with the policy and is shown there rather than being assigned to a guess.