JULIA JOHNSON
Subscriber on policy B01M000196
Claims
3
Attributed to this person
Charged
1,129.00
Total submitted
Denied
122.00
1 denied claims
Patient responsibility
20.00
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 | JULIA JOHNSON |
| Role on the policy | Subscriber |
| Policy | B01M000196 |
| Date of birth | 3 Dec 1965 |
| Plan | SILVER HMO |
| Covered from | 16 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000836 | 12 Dec 2024 | 116.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000837 | 8 Oct 2024 | 891.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000835 | 24 Sep 2024 | 122.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 122.00 |