ELENA JOHNSON
Dependent on policy B02M000464
Claims
2
Attributed to this person
Charged
826.00
Total submitted
Denied
826.00
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 | ELENA JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000464 |
| Date of birth | 18 Jan 1981 |
| Plan | PLATINUM PPO |
| Covered from | 16 Jul 2024 |
| Covered to | 16 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 |
|---|---|---|---|---|---|
| CLM0001984 | 24 Oct 2024 | 712.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 712.00 |
| CLM0001985 | 29 Jun 2024 | 114.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 114.00 |