GRACE JOHNSON
Subscriber on policy B03M000158
Claims
3
Attributed to this person
Charged
710.00
Total submitted
Denied
639.00
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 | GRACE JOHNSON |
| Role on the policy | Subscriber |
| Policy | B03M000158 |
| Date of birth | 23 Dec 1962 |
| Plan | PLATINUM PPO |
| Covered from | 21 May 2024 |
| Covered to | 9 Sep 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 |
|---|---|---|---|---|---|
| CLM0000644 | 20 Oct 2024 | 168.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 168.00 |
| CLM0000646 | 16 Oct 2024 | 471.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 471.00 |
| CLM0000645 | 18 Jun 2024 | 71.00 | NORTHSTAR MUTUAL | Not denied | — |