IVAN JOHNSON
Dependent on policy B01M000212
Claims
3
Attributed to this person
Charged
1,533.00
Total submitted
Denied
201.00
1 denied claims
Patient responsibility
30.00
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 | IVAN JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000212 |
| Date of birth | 28 Nov 1977 |
| Plan | SILVER HMO |
| Covered from | 25 Jan 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000902 | 14 Aug 2026 | 719.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000903 | 16 May 2026 | 613.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000901 | 10 May 2026 | 201.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 201.00 |