TOMAS OKAFOR
Dependent on policy B10M000572
Claims
3
Attributed to this person
Charged
1,017.00
Total submitted
Denied
852.00
3 denied claims
Patient responsibility
107.25
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 | TOMAS OKAFOR |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000572 |
| Date of birth | 14 May 1984 |
| Plan | SILVER HMO |
| Covered from | 16 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 107.25 |
| Total | 107.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002369 | 23 Jan 2026 | 165.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002368 | 31 Oct 2025 | 784.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 784.00 |
| CLM0002367 | 10 Oct 2025 | 68.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 68.00 |