OMAR NGUYEN
Dependent on policy B04M000568
Claims
2
Attributed to this person
Charged
944.00
Total submitted
Denied
820.00
2 denied claims
Patient responsibility
80.60
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 19 |
| Policy | B04M000568 |
| Date of birth | 27 Nov 2013 |
| Plan | PLATINUM PPO |
| Covered from | 10 Jul 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 80.60 |
| Total | 80.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002489 | 30 Jan 2026 | 124.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002490 | 12 Jun 2025 | 820.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 820.00 |