PRIYA NGUYEN
Dependent on policy B07M000727
Claims
3
Attributed to this person
Charged
1,748.00
Total submitted
Denied
373.93
1 denied claims
Patient responsibility
30.00
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 | PRIYA NGUYEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000727 |
| Date of birth | 5 Jan 1994 |
| Plan | SILVER HMO |
| Covered from | 7 Sep 2024 |
| Covered to | 22 Apr 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003008 | 21 Mar 2025 | 365.00 | CASCADE CARE | Not denied | — |
| CLM0003009 | 15 Mar 2025 | 502.00 | CASCADE CARE | Not denied | — |
| CLM0003007 | 21 Jan 2025 | 881.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 373.93 |