TOMAS NGUYEN
Subscriber on policy B04M000184
Claims
2
Attributed to this person
Charged
1,293.00
Total submitted
Denied
832.00
1 denied claims
Patient responsibility
69.15
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 | TOMAS NGUYEN |
| Role on the policy | Subscriber |
| Policy | B04M000184 |
| Date of birth | 10 Apr 1971 |
| Plan | BRONZE EPO |
| Covered from | 18 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 69.15 |
| Total | 69.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000828 | 11 Dec 2024 | 461.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000827 | 10 Mar 2024 | 832.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 832.00 |