SOFIA JOHNSON
Dependent on policy B04M000562
Claims
2
Attributed to this person
Charged
814.00
Total submitted
Denied
503.36
2 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 | SOFIA JOHNSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000562 |
| Date of birth | 27 Jan 1960 |
| Plan | GOLD PPO |
| Covered from | 3 Jun 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0002467 | 20 Mar 2025 | 515.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 204.36 |
| CLM0002466 | 5 May 2024 | 299.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 299.00 |