IVAN NGUYEN
Subscriber on policy B04M000320
Claims
3
Attributed to this person
Charged
849.00
Total submitted
Denied
550.00
3 denied claims
Patient responsibility
194.35
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 NGUYEN |
| Role on the policy | Subscriber |
| Policy | B04M000320 |
| Date of birth | 16 Jun 1964 |
| Plan | SILVER HMO |
| Covered from | 11 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 194.35 |
| Total | 194.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001398 | 6 Feb 2026 | 340.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 340.00 |
| CLM0001399 | 2 May 2025 | 299.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001400 | 26 Apr 2024 | 210.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 210.00 |