OMAR NGUYEN
Dependent on policy B04M000237
Claims
2
Attributed to this person
Charged
643.00
Total submitted
Denied
389.00
1 denied claims
Patient responsibility
0.00
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 | OMAR NGUYEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000237 |
| Date of birth | 9 Jun 2002 |
| Plan | GOLD PPO |
| Covered from | 25 Aug 2024 |
| Covered to | 23 Feb 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001032 | 18 Feb 2025 | 254.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001031 | 10 Sep 2024 | 389.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 389.00 |