RAVI JOHNSON
Subscriber on policy B04M000170
Claims
1
Attributed to this person
Charged
681.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
442.65
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 | RAVI JOHNSON |
| Role on the policy | Subscriber |
| Policy | B04M000170 |
| Date of birth | 3 Sep 2001 |
| Plan | GOLD PPO |
| Covered from | 12 Jan 2025 |
| Covered to | 11 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 442.65 |
| Total | 442.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000777 | 15 Mar 2025 | 681.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |