TOMAS JOHNSON
Subscriber on policy B02M000300
Claims
2
Attributed to this person
Charged
510.00
Total submitted
Denied
267.29
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 | B02M000300 |
| Date of birth | 31 Jul 1970 |
| Plan | BRONZE EPO |
| Covered from | 12 May 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 |
|---|---|---|---|---|---|
| CLM0001294 | 17 Mar 2026 | 316.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 73.29 |
| CLM0001295 | 11 Jul 2025 | 194.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 194.00 |