TOMAS CHEN
Dependent on policy B01M000507
Claims
3
Attributed to this person
Charged
1,413.00
Total submitted
Denied
517.29
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 CHEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000507 |
| Date of birth | 18 Aug 2010 |
| Plan | GOLD PPO |
| Covered from | 29 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002279 | 16 Oct 2025 | 163.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 77.29 |
| CLM0002278 | 31 Aug 2025 | 440.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 440.00 |
| CLM0002277 | 15 Jun 2025 | 810.00 | NORTHSTAR MUTUAL | Not denied | — |