OMAR JOHNSON
Dependent on policy B03M000198
Claims
2
Attributed to this person
Charged
1,482.00
Total submitted
Denied
0.00
0 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 | B03M000198 |
| Date of birth | 26 May 2022 |
| Plan | GOLD PPO |
| Covered from | 15 Aug 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0000823 | 6 Nov 2024 | 868.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000824 | 2 Oct 2024 | 614.00 | NORTHSTAR MUTUAL | Not denied | — |