RAVI JOHNSON
Subscriber on policy B02M000628
Claims
3
Attributed to this person
Charged
687.00
Total submitted
Denied
687.00
3 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 | RAVI JOHNSON |
| Role on the policy | Subscriber |
| Policy | B02M000628 |
| Date of birth | 21 Jul 1994 |
| Plan | BRONZE EPO |
| Covered from | 8 Jul 2024 |
| Covered to | 14 Oct 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 |
|---|---|---|---|---|---|
| CLM0002642 | 10 Nov 2024 | 68.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 68.00 |
| CLM0002641 | 29 Oct 2024 | 295.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 295.00 |
| CLM0002640 | 3 Oct 2024 | 324.00 | CASCADE CARE | CARC 96 · NON_COVERED | 324.00 |