UMA NGUYEN
Dependent on policy B06M000019
Claims
3
Attributed to this person
Charged
1,020.00
Total submitted
Denied
245.00
1 denied claims
Patient responsibility
31.95
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 | UMA NGUYEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000019 |
| Date of birth | 21 Sep 2017 |
| Plan | GOLD PPO |
| Covered from | 26 Apr 2025 |
| Covered to | 27 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 31.95 |
| Total | 31.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000121 | 1 Aug 2025 | 562.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000122 | 3 Jul 2025 | 245.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 245.00 |
| CLM0000123 | 19 Jun 2025 | 213.00 | NORTHSTAR MUTUAL | Not denied | — |