SOFIA JOHNSON
Dependent on policy B03M000118
Claims
3
Attributed to this person
Charged
1,012.00
Total submitted
Denied
792.00
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 | SOFIA JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000118 |
| Date of birth | 29 Sep 1980 |
| Plan | SILVER HMO |
| Covered from | 30 Jun 2024 |
| Covered to | 8 Nov 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 |
|---|---|---|---|---|---|
| CLM0000462 | 1 Oct 2024 | 111.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000461 | 24 Aug 2024 | 109.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000463 | 11 Jun 2024 | 792.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 792.00 |