ZARA DIAZ
Subscriber on policy B01M000583
Claims
2
Attributed to this person
Charged
1,122.00
Total submitted
Denied
620.00
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 | ZARA DIAZ |
| Role on the policy | Subscriber |
| Policy | B01M000583 |
| Date of birth | 1 Aug 1972 |
| Plan | BRONZE EPO |
| Covered from | 29 Jan 2024 |
| Covered to | 20 Oct 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002604 | 20 Sep 2024 | 620.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 620.00 |
| CLM0002603 | 31 Mar 2024 | 502.00 | NORTHSTAR MUTUAL | Not denied | — |