PRIYA CHEN
Dependent on policy B04M000381
Claims
2
Attributed to this person
Charged
177.00
Total submitted
Denied
68.00
1 denied claims
Patient responsibility
16.35
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 | PRIYA CHEN |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000381 |
| Date of birth | 21 Feb 1960 |
| Plan | BRONZE EPO |
| Covered from | 7 Aug 2024 |
| Covered to | 14 Mar 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 16.35 |
| Total | 16.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001631 | 17 Apr 2025 | 109.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001630 | 20 Jul 2024 | 68.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 68.00 |