PRIYA JOHNSON
Subscriber on policy B03M000705
Claims
3
Attributed to this person
Charged
1,510.00
Total submitted
Denied
651.67
3 denied claims
Patient responsibility
525.85
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 | PRIYA JOHNSON |
| Role on the policy | Subscriber |
| Policy | B03M000705 |
| Date of birth | 18 May 1993 |
| Plan | PLATINUM PPO |
| Covered from | 2 Feb 2025 |
| Covered to | 13 Sep 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 525.85 |
| Total | 525.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002934 | 29 Sep 2025 | 809.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0002932 | 17 Aug 2025 | 619.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 619.00 |
| CLM0002933 | 21 Mar 2025 | 82.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 32.67 |