OMAR NGUYEN
Subscriber on policy B09M000685
Claims
3
Attributed to this person
Charged
2,028.00
Total submitted
Denied
460.22
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 | OMAR NGUYEN |
| Role on the policy | Subscriber |
| Policy | B09M000685 |
| Date of birth | 2 Aug 1967 |
| Plan | BRONZE EPO |
| Covered from | 7 Mar 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 |
|---|---|---|---|---|---|
| CLM0002916 | 20 Nov 2024 | 829.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 262.96 |
| CLM0002915 | 30 Oct 2024 | 752.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002914 | 19 Sep 2024 | 447.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 197.26 |