CARLA NGUYEN
Dependent on policy B03M000351
Claims
3
Attributed to this person
Charged
1,815.00
Total submitted
Denied
155.68
1 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 | CARLA NGUYEN |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000351 |
| Date of birth | 18 Feb 1983 |
| Plan | BRONZE EPO |
| Covered from | 14 Jan 2024 |
| Covered to | 24 Jul 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001412 | 22 Jul 2024 | 472.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 155.68 |
| CLM0001413 | 2 May 2024 | 762.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001414 | 25 Apr 2024 | 581.00 | NORTHSTAR MUTUAL | Not denied | — |