OMAR JOHNSON
Subscriber on policy B01M000073
Claims
2
Attributed to this person
Charged
483.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
25.80
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 | Subscriber |
| Policy | B01M000073 |
| Date of birth | 3 Feb 1951 |
| Plan | SILVER HMO |
| Covered from | 16 May 2024 |
| Covered to | 2 Sep 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 25.80 |
| Total | 25.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000305 | 29 Jul 2024 | 354.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000306 | 19 Jul 2024 | 129.00 | NORTHSTAR MUTUAL | Not denied | — |