TOMAS CHEN
Subscriber on policy B10M000246
Claims
2
Attributed to this person
Charged
1,306.00
Total submitted
Denied
677.00
2 denied claims
Patient responsibility
408.85
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 | B10M000246 |
| Date of birth | 25 Mar 1987 |
| Plan | GOLD PPO |
| Covered from | 5 Dec 2024 |
| Covered to | 13 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 408.85 |
| Total | 408.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001011 | 23 Feb 2025 | 677.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 677.00 |
| CLM0001012 | 18 Jan 2025 | 629.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |