CARLA CHEN
Dependent on policy B07M000771
Claims
3
Attributed to this person
Charged
1,719.00
Total submitted
Denied
1,239.74
3 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 | CARLA CHEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000771 |
| Date of birth | 27 Dec 1990 |
| Plan | SILVER HMO |
| Covered from | 2 Aug 2024 |
| Covered to | 3 Dec 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003193 | 31 Jan 2025 | 808.00 | CASCADE CARE | CARC 18 · DUPLICATE | 808.00 |
| CLM0003194 | 14 Jan 2025 | 216.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 216.00 |
| CLM0003195 | 17 Oct 2024 | 695.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 215.74 |