ZARA JOHNSON
Subscriber on policy B06M000260
Claims
2
Attributed to this person
Charged
920.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
40.30
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 | ZARA JOHNSON |
| Role on the policy | Subscriber |
| Policy | B06M000260 |
| Date of birth | 21 May 1982 |
| Plan | GOLD PPO |
| Covered from | 27 Mar 2025 |
| Covered to | 8 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 40.30 |
| Total | 40.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001229 | 22 May 2025 | 62.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001228 | 15 May 2025 | 858.00 | NORTHSTAR MUTUAL | Not denied | — |