TOMAS NGUYEN
Dependent on policy B03M000328
Claims
3
Attributed to this person
Charged
1,764.00
Total submitted
Denied
1,359.00
2 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 | TOMAS NGUYEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000328 |
| Date of birth | 3 Aug 1981 |
| Plan | SILVER HMO |
| Covered from | 13 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001308 | 6 Oct 2025 | 740.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 740.00 |
| CLM0001306 | 2 Jul 2025 | 405.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001307 | 17 Apr 2025 | 619.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 619.00 |