JULIA NGUYEN
Subscriber on policy B04M000762
Claims
3
Attributed to this person
Charged
644.00
Total submitted
Denied
101.00
1 denied claims
Patient responsibility
39.00
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 | JULIA NGUYEN |
| Role on the policy | Subscriber |
| Policy | B04M000762 |
| Date of birth | 23 Jul 1969 |
| Plan | GOLD PPO |
| Covered from | 17 Jan 2024 |
| Covered to | 20 Jul 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 39.00 |
| Total | 39.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003318 | 4 Jun 2024 | 195.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003317 | 5 Mar 2024 | 348.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003319 | 19 Feb 2024 | 101.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 101.00 |