BRIAN NGUYEN
Dependent on policy B03M000328
Claims
2
Attributed to this person
Charged
1,321.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
493.65
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 | BRIAN NGUYEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000328 |
| Date of birth | 26 Jul 2015 |
| Plan | SILVER HMO |
| Covered from | 13 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 384.15 |
| CARC 1 · Deductible | 1 | 109.50 |
| Total | 493.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001309 | 3 Oct 2025 | 591.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001310 | 7 Sep 2025 | 730.00 | NORTHSTAR MUTUAL | Not denied | — |