NADIA JOHNSON
Subscriber on policy B01M000253
Claims
3
Attributed to this person
Charged
1,656.00
Total submitted
Denied
505.00
2 denied claims
Patient responsibility
411.45
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 | NADIA JOHNSON |
| Role on the policy | Subscriber |
| Policy | B01M000253 |
| Date of birth | 20 Nov 1966 |
| Plan | SILVER HMO |
| Covered from | 26 Jul 2024 |
| Covered to | 10 Jan 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 411.45 |
| Total | 411.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001079 | 5 Dec 2024 | 633.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001078 | 23 Jul 2024 | 505.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 505.00 |
| CLM0001077 | 14 Jul 2024 | 518.00 | NORTHSTAR MUTUAL | Not denied | — |