ELENA JOHNSON
Subscriber on policy B10M000377
Claims
1
Attributed to this person
Charged
123.00
Total submitted
Denied
123.00
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 | ELENA JOHNSON |
| Role on the policy | Subscriber |
| Policy | B10M000377 |
| Date of birth | 10 Feb 1962 |
| Plan | PLATINUM PPO |
| Covered from | 28 May 2025 |
| Covered to | 5 Dec 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001566 | 10 May 2025 | 123.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 123.00 |