DAVID OKAFOR
Dependent on policy B03M000583
Claims
3
Attributed to this person
Charged
1,394.00
Total submitted
Denied
1,065.00
2 denied claims
Patient responsibility
50.00
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 | DAVID OKAFOR |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000583 |
| Date of birth | 23 Jul 1991 |
| Plan | GOLD PPO |
| Covered from | 23 Nov 2024 |
| Covered to | 8 Sep 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002382 | 26 Jan 2025 | 329.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002381 | 13 Dec 2024 | 666.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 666.00 |
| CLM0002380 | 5 Nov 2024 | 399.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 399.00 |