GRACE JOHNSON
Subscriber on policy B08M000059
Claims
2
Attributed to this person
Charged
1,411.00
Total submitted
Denied
576.00
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 | GRACE JOHNSON |
| Role on the policy | Subscriber |
| Policy | B08M000059 |
| Date of birth | 22 Dec 1977 |
| Plan | GOLD PPO |
| Covered from | 21 Jan 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 |
|---|---|---|---|---|---|
| CLM0000269 | 22 Mar 2025 | 576.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 576.00 |
| CLM0000270 | 29 Dec 2023 | 835.00 | NORTHSTAR MUTUAL | Not denied | — |