OMAR JOHNSON
Dependent on policy B02M000195
Claims
1
Attributed to this person
Charged
80.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
52.00
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 | B02M000195 |
| Date of birth | 18 Nov 1960 |
| Plan | SILVER HMO |
| Covered from | 11 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 52.00 |
| Total | 52.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000851 | 9 Apr 2025 | 80.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |