OMAR NGUYEN
Subscriber on policy B02M000636
Claims
3
Attributed to this person
Charged
983.00
Total submitted
Denied
603.00
2 denied claims
Patient responsibility
50.00
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 | B02M000636 |
| Date of birth | 10 Sep 1959 |
| Plan | GOLD PPO |
| Covered from | 13 Jan 2024 |
| Covered to | 19 Jun 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002677 | 5 Aug 2024 | 539.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 539.00 |
| CLM0002676 | 6 Mar 2024 | 64.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 64.00 |
| CLM0002675 | 31 Dec 2023 | 380.00 | CASCADE CARE | Not denied | — |