KEVIN CHEN
Dependent on policy B02M000568
Claims
3
Attributed to this person
Charged
903.00
Total submitted
Denied
28.31
1 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 | KEVIN CHEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000568 |
| Date of birth | 21 May 2003 |
| Plan | GOLD PPO |
| Covered from | 3 Jan 2025 |
| Covered to | 18 Jul 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 |
|---|---|---|---|---|---|
| CLM0002393 | 25 Jun 2025 | 115.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 28.31 |
| CLM0002394 | 9 Apr 2025 | 210.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002392 | 16 Feb 2025 | 578.00 | NORTHSTAR MUTUAL | Not denied | — |