BRIAN JOHNSON
Subscriber on policy B02M000111
Claims
2
Attributed to this person
Charged
410.00
Total submitted
Denied
327.00
2 denied claims
Patient responsibility
53.95
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 | BRIAN JOHNSON |
| Role on the policy | Subscriber |
| Policy | B02M000111 |
| Date of birth | 4 Nov 2001 |
| Plan | SILVER HMO |
| Covered from | 5 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 53.95 |
| Total | 53.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000499 | 19 Oct 2025 | 83.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0000498 | 11 Apr 2024 | 327.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 327.00 |