OMAR JOHNSON
Dependent on policy B02M000529
Claims
2
Attributed to this person
Charged
652.00
Total submitted
Denied
652.00
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 | OMAR JOHNSON |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000529 |
| Date of birth | 5 Aug 1987 |
| Plan | BRONZE EPO |
| Covered from | 24 Jan 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0002241 | 6 May 2026 | 170.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 170.00 |
| CLM0002240 | 28 Jul 2025 | 482.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 482.00 |