GRACE JOHNSON
Subscriber on policy B02M000299
Claims
1
Attributed to this person
Charged
179.00
Total submitted
Denied
179.00
1 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 | GRACE JOHNSON |
| Role on the policy | Subscriber |
| Policy | B02M000299 |
| Date of birth | 20 Jun 2002 |
| Plan | BRONZE EPO |
| Covered from | 4 Dec 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 |
|---|---|---|---|---|---|
| CLM0001287 | 21 Nov 2024 | 179.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 179.00 |