OMAR NGUYEN
Subscriber on policy B03M000328
Claims
3
Attributed to this person
Charged
1,395.00
Total submitted
Denied
456.00
1 denied claims
Patient responsibility
112.80
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 | B03M000328 |
| Date of birth | 1 Feb 1972 |
| Plan | SILVER HMO |
| Covered from | 13 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 112.80 |
| Total | 112.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001304 | 9 Jul 2026 | 187.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001303 | 24 Apr 2025 | 456.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 456.00 |
| CLM0001305 | 29 Jan 2025 | 752.00 | NORTHSTAR MUTUAL | Not denied | — |