SOFIA JOHNSON
Subscriber on policy B07M000537
Claims
3
Attributed to this person
Charged
1,292.00
Total submitted
Denied
1,054.00
2 denied claims
Patient responsibility
35.70
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 | SOFIA JOHNSON |
| Role on the policy | Subscriber |
| Policy | B07M000537 |
| Date of birth | 1 Jun 1991 |
| Plan | BRONZE EPO |
| Covered from | 24 May 2025 |
| Covered to | 31 Jul 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 35.70 |
| Total | 35.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002283 | 30 May 2025 | 194.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 194.00 |
| CLM0002282 | 23 May 2025 | 238.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002284 | 5 May 2025 | 860.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 860.00 |