IVAN CHEN
Subscriber on policy B04M000132
Claims
3
Attributed to this person
Charged
2,139.00
Total submitted
Denied
1,266.00
3 denied claims
Patient responsibility
567.45
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 | IVAN CHEN |
| Role on the policy | Subscriber |
| Policy | B04M000132 |
| Date of birth | 21 Jun 1950 |
| Plan | SILVER HMO |
| Covered from | 7 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 567.45 |
| Total | 567.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000603 | 16 Dec 2025 | 499.00 | MERIDIAN HEALTH PLAN | CARC 11 · CODING | 499.00 |
| CLM0000602 | 3 Oct 2025 | 767.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 767.00 |
| CLM0000604 | 10 Jun 2025 | 873.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |