HENRY JOHNSON
Dependent on policy B09M000256
Claims
2
Attributed to this person
Charged
1,411.00
Total submitted
Denied
199.73
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 | HENRY JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000256 |
| Date of birth | 15 Apr 1989 |
| Plan | SILVER HMO |
| Covered from | 20 Apr 2024 |
| Covered to | 11 Aug 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 |
|---|---|---|---|---|---|
| CLM0001038 | 9 Jul 2024 | 718.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 199.73 |
| CLM0001037 | 13 Jun 2024 | 693.00 | NORTHSTAR MUTUAL | Not denied | — |