OMAR JOHNSON
Dependent on policy B09M000503
Claims
2
Attributed to this person
Charged
925.00
Total submitted
Denied
925.00
2 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 | OMAR JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000503 |
| Date of birth | 30 May 2012 |
| Plan | GOLD PPO |
| Covered from | 11 Jul 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 |
|---|---|---|---|---|---|
| CLM0002123 | 25 Jan 2026 | 785.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 785.00 |
| CLM0002124 | 25 Aug 2024 | 140.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 140.00 |