RAVI NGUYEN
Dependent on policy B06M000782
Claims
2
Attributed to this person
Charged
453.00
Total submitted
Denied
278.00
1 denied claims
Patient responsibility
26.25
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 NGUYEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B06M000782 |
| Date of birth | 3 Dec 1955 |
| Plan | SILVER HMO |
| Covered from | 25 Jan 2025 |
| Covered to | 15 May 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 26.25 |
| Total | 26.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003452 | 20 Jun 2025 | 278.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 278.00 |
| CLM0003451 | 2 Feb 2025 | 175.00 | NORTHSTAR MUTUAL | Not denied | — |