TOMAS OKAFOR
Dependent on policy B07M000843
Claims
1
Attributed to this person
Charged
528.00
Total submitted
Denied
21.84
1 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 OKAFOR |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000843 |
| Date of birth | 25 Apr 1997 |
| Plan | PLATINUM PPO |
| Covered from | 3 May 2024 |
| Covered to | 27 Oct 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 |
|---|---|---|---|---|---|
| CLM0003466 | 7 May 2024 | 528.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 21.84 |