RAVI JOHNSON
Subscriber on policy B09M000087
Claims
2
Attributed to this person
Charged
745.00
Total submitted
Denied
92.00
1 denied claims
Patient responsibility
130.60
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 | RAVI JOHNSON |
| Role on the policy | Subscriber |
| Policy | B09M000087 |
| Date of birth | 8 Jun 1952 |
| Plan | SILVER HMO |
| Covered from | 9 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 130.60 |
| Total | 130.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000366 | 28 Nov 2025 | 92.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 92.00 |
| CLM0000365 | 2 Jan 2025 | 653.00 | NORTHSTAR MUTUAL | Not denied | — |