IVAN JOHNSON
Subscriber on policy B04M000829
Claims
3
Attributed to this person
Charged
1,764.00
Total submitted
Denied
1,094.00
2 denied claims
Patient responsibility
134.00
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 | IVAN JOHNSON |
| Role on the policy | Subscriber |
| Policy | B04M000829 |
| Date of birth | 10 Oct 1977 |
| Plan | SILVER HMO |
| Covered from | 18 May 2025 |
| Covered to | 12 Oct 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 134.00 |
| Total | 134.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003594 | 22 Oct 2025 | 670.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003593 | 4 Jun 2025 | 712.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 712.00 |
| CLM0003595 | 5 May 2025 | 382.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 382.00 |