TOMAS CHEN
Subscriber on policy B08M000023
Claims
2
Attributed to this person
Charged
1,391.00
Total submitted
Denied
1,391.00
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 | TOMAS CHEN |
| Role on the policy | Subscriber |
| Policy | B08M000023 |
| Date of birth | 19 Nov 1973 |
| Plan | PLATINUM PPO |
| Covered from | 18 Jan 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 |
|---|---|---|---|---|---|
| CLM0000101 | 12 Jan 2025 | 713.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 713.00 |
| CLM0000100 | 9 Jan 2024 | 678.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 678.00 |