OMAR NGUYEN
Subscriber on policy B03M000783
Claims
3
Attributed to this person
Charged
759.00
Total submitted
Denied
174.00
1 denied claims
Patient responsibility
91.80
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 | B03M000783 |
| Date of birth | 25 May 2001 |
| Plan | BRONZE EPO |
| Covered from | 21 May 2024 |
| Covered to | 25 Aug 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 75.60 |
| CARC 2 · Coinsurance | 1 | 16.20 |
| Total | 91.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003321 | 30 Sep 2024 | 174.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 174.00 |
| CLM0003320 | 12 Jul 2024 | 81.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003319 | 27 Apr 2024 | 504.00 | MERIDIAN HEALTH PLAN | Not denied | — |