IVAN JOHNSON
Subscriber on policy B01M000802
Claims
3
Attributed to this person
Charged
1,197.00
Total submitted
Denied
1,197.00
3 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 | IVAN JOHNSON |
| Role on the policy | Subscriber |
| Policy | B01M000802 |
| Date of birth | 29 Dec 1957 |
| Plan | GOLD PPO |
| Covered from | 6 Jul 2024 |
| Covered to | 11 Dec 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 |
|---|---|---|---|---|---|
| CLM0003566 | 2 Sep 2024 | 330.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 330.00 |
| CLM0003565 | 22 Jun 2024 | 659.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 659.00 |
| CLM0003567 | 20 Jun 2024 | 208.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 208.00 |