CARLA JOHNSON
Subscriber on policy B06M000892
Claims
2
Attributed to this person
Charged
1,152.00
Total submitted
Denied
1,152.00
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 | CARLA JOHNSON |
| Role on the policy | Subscriber |
| Policy | B06M000892 |
| Date of birth | 14 Mar 1999 |
| Plan | PLATINUM PPO |
| Covered from | 7 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003886 | 21 Dec 2024 | 563.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 563.00 |
| CLM0003885 | 19 Nov 2024 | 589.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 589.00 |