GRACE NGUYEN
Subscriber on policy B06M000275
Claims
2
Attributed to this person
Charged
496.00
Total submitted
Denied
145.05
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 | GRACE NGUYEN |
| Role on the policy | Subscriber |
| Policy | B06M000275 |
| Date of birth | 13 Oct 1955 |
| Plan | PLATINUM PPO |
| Covered from | 21 Feb 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0001285 | 24 Oct 2024 | 402.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 120.00 |
| CLM0001284 | 7 May 2024 | 94.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 25.05 |