PRIYA NGUYEN
Dependent on policy B09M000136
Claims
3
Attributed to this person
Charged
1,081.00
Total submitted
Denied
395.00
1 denied claims
Patient responsibility
67.65
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 | B09M000136 |
| Date of birth | 6 Dec 2010 |
| Plan | SILVER HMO |
| Covered from | 3 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 67.65 |
| Total | 67.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000559 | 16 Jun 2025 | 235.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000561 | 20 May 2025 | 451.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000560 | 23 Feb 2025 | 395.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 395.00 |