BRIAN NGUYEN
Subscriber on policy B07M000751
Claims
2
Attributed to this person
Charged
875.00
Total submitted
Denied
261.00
1 denied claims
Patient responsibility
20.00
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 | BRIAN NGUYEN |
| Role on the policy | Subscriber |
| Policy | B07M000751 |
| Date of birth | 16 Apr 1983 |
| Plan | BRONZE EPO |
| Covered from | 19 Sep 2024 |
| Covered to | 12 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003108 | 15 Sep 2024 | 261.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 261.00 |
| CLM0003107 | 25 Aug 2024 | 614.00 | CASCADE CARE | Not denied | — |