RAVI JOHNSON
Subscriber on policy B02M000070
Claims
2
Attributed to this person
Charged
873.00
Total submitted
Denied
729.53
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 | RAVI JOHNSON |
| Role on the policy | Subscriber |
| Policy | B02M000070 |
| Date of birth | 19 Feb 1971 |
| Plan | PLATINUM PPO |
| Covered from | 7 Jun 2024 |
| Covered to | 25 Dec 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000322 | 18 Dec 2024 | 622.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 622.00 |
| CLM0000323 | 7 Dec 2024 | 251.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 107.53 |