TOMAS CHEN
Dependent on policy B10M000246
Claims
3
Attributed to this person
Charged
1,977.00
Total submitted
Denied
1,977.00
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 | TOMAS CHEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000246 |
| Date of birth | 1 Dec 2022 |
| Plan | GOLD PPO |
| Covered from | 5 Dec 2024 |
| Covered to | 13 Mar 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001016 | 6 Apr 2025 | 435.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 435.00 |
| CLM0001017 | 4 Apr 2025 | 661.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 661.00 |
| CLM0001018 | 25 Jan 2025 | 881.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 881.00 |