MARCUS DIAZ
Subscriber on policy B01M000621
Claims
3
Attributed to this person
Charged
802.00
Total submitted
Denied
64.19
1 denied claims
Patient responsibility
64.50
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 | MARCUS DIAZ |
| Role on the policy | Subscriber |
| Policy | B01M000621 |
| Date of birth | 22 Feb 1973 |
| Plan | BRONZE EPO |
| Covered from | 19 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 64.50 |
| Total | 64.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002776 | 3 Feb 2026 | 235.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 64.19 |
| CLM0002774 | 18 Nov 2025 | 430.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002775 | 6 Jul 2025 | 137.00 | NORTHSTAR MUTUAL | Not denied | — |