BRIAN OKAFOR
Subscriber on policy B08M000816
Claims
1
Attributed to this person
Charged
713.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
463.45
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 | BRIAN OKAFOR |
| Role on the policy | Subscriber |
| Policy | B08M000816 |
| Date of birth | 4 May 1950 |
| Plan | SILVER HMO |
| Covered from | 22 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 463.45 |
| Total | 463.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003652 | 2 Aug 2024 | 713.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |