AMARA NGUYEN
Dependent on policy B10M000634
Claims
3
Attributed to this person
Charged
2,322.00
Total submitted
Denied
1,743.00
3 denied claims
Patient responsibility
376.35
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 | AMARA NGUYEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000634 |
| Date of birth | 20 Jan 1963 |
| Plan | SILVER HMO |
| Covered from | 11 Jan 2025 |
| Covered to | 31 Jul 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 376.35 |
| Total | 376.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002631 | 1 Jul 2025 | 579.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002630 | 17 Apr 2025 | 890.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 890.00 |
| CLM0002629 | 3 Mar 2025 | 853.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 853.00 |