RAVI OKAFOR
Dependent on policy B05M000204
Claims
3
Attributed to this person
Charged
1,477.00
Total submitted
Denied
281.00
2 denied claims
Patient responsibility
565.50
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 | RAVI OKAFOR |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000204 |
| Date of birth | 18 Nov 1998 |
| Plan | PLATINUM PPO |
| Covered from | 22 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 565.50 |
| Total | 565.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000857 | 16 Aug 2026 | 326.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000858 | 8 Sep 2025 | 870.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0000856 | 18 May 2025 | 281.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 281.00 |