TOMAS JOHNSON
Subscriber on policy B10M000726
Claims
2
Attributed to this person
Charged
1,345.00
Total submitted
Denied
967.96
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 | TOMAS JOHNSON |
| Role on the policy | Subscriber |
| Policy | B10M000726 |
| Date of birth | 28 Dec 2000 |
| Plan | PLATINUM PPO |
| Covered from | 4 Nov 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 |
|---|---|---|---|---|---|
| CLM0003050 | 18 Sep 2025 | 602.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 224.96 |
| CLM0003049 | 23 Feb 2025 | 743.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 743.00 |