TOMAS OKAFOR
Dependent on policy B05M000671
Claims
3
Attributed to this person
Charged
1,098.00
Total submitted
Denied
536.00
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 | TOMAS OKAFOR |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000671 |
| Date of birth | 2 May 1985 |
| Plan | GOLD PPO |
| Covered from | 1 Jul 2024 |
| Covered to | 25 Jan 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002894 | 6 Dec 2024 | 562.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002892 | 26 Oct 2024 | 339.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 339.00 |
| CLM0002893 | 9 Jun 2024 | 197.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 197.00 |