TOMAS OKAFOR
Subscriber on policy B03M000731
Claims
3
Attributed to this person
Charged
1,377.00
Total submitted
Denied
210.00
1 denied claims
Patient responsibility
79.05
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 OKAFOR |
| Role on the policy | Subscriber |
| Policy | B03M000731 |
| Date of birth | 19 Aug 1970 |
| Plan | GOLD PPO |
| Covered from | 11 Jul 2024 |
| Covered to | 5 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 79.05 |
| Total | 79.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003059 | 12 Oct 2024 | 640.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003061 | 27 Jun 2024 | 210.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 210.00 |
| CLM0003060 | 23 Jun 2024 | 527.00 | MERIDIAN HEALTH PLAN | Not denied | — |