ELENA JOHNSON
Subscriber on policy B04M000655
Claims
3
Attributed to this person
Charged
859.00
Total submitted
Denied
443.92
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 | ELENA JOHNSON |
| Role on the policy | Subscriber |
| Policy | B04M000655 |
| Date of birth | 21 Sep 2001 |
| Plan | SILVER HMO |
| Covered from | 25 Mar 2024 |
| Covered to | 22 Dec 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002855 | 2 Jan 2025 | 337.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 337.00 |
| CLM0002853 | 15 Dec 2024 | 283.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002854 | 15 Sep 2024 | 239.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 106.92 |