TOMAS JOHNSON
Subscriber on policy B07M000489
Claims
3
Attributed to this person
Charged
1,935.00
Total submitted
Denied
1,541.71
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 | TOMAS JOHNSON |
| Role on the policy | Subscriber |
| Policy | B07M000489 |
| Date of birth | 7 Mar 1966 |
| Plan | PLATINUM PPO |
| Covered from | 1 Dec 2024 |
| Covered to | 4 Sep 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002092 | 5 Sep 2025 | 431.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 431.00 |
| CLM0002091 | 28 Jun 2025 | 772.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 772.00 |
| CLM0002090 | 11 Mar 2025 | 732.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 338.71 |