TOMAS JOHNSON
Subscriber on policy B03M000522
Claims
3
Attributed to this person
Charged
583.00
Total submitted
Denied
362.00
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 | TOMAS JOHNSON |
| Role on the policy | Subscriber |
| Policy | B03M000522 |
| Date of birth | 2 Mar 1981 |
| Plan | GOLD PPO |
| Covered from | 16 May 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0002140 | 11 Jun 2026 | 362.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 362.00 |
| CLM0002138 | 10 Oct 2025 | 132.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002139 | 20 Jul 2025 | 89.00 | NORTHSTAR MUTUAL | Not denied | — |