OMAR NGUYEN
Subscriber on policy B03M000516
Claims
3
Attributed to this person
Charged
1,887.00
Total submitted
Denied
299.21
1 denied claims
Patient responsibility
113.40
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 | B03M000516 |
| Date of birth | 14 Oct 2004 |
| Plan | SILVER HMO |
| Covered from | 24 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 113.40 |
| Total | 113.40 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002119 | 31 Jul 2026 | 733.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 299.21 |
| CLM0002118 | 15 Oct 2025 | 398.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002117 | 4 Jul 2024 | 756.00 | NORTHSTAR MUTUAL | Not denied | — |