ZARA DIAZ
Dependent on policy B06M000851
Claims
3
Attributed to this person
Charged
1,082.00
Total submitted
Denied
74.00
1 denied claims
Patient responsibility
96.30
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 | Dependent · relationship 19 |
| Policy | B06M000851 |
| Date of birth | 5 May 1985 |
| Plan | PLATINUM PPO |
| Covered from | 27 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 96.30 |
| Total | 96.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003722 | 16 Nov 2025 | 642.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003723 | 5 Aug 2025 | 74.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 74.00 |
| CLM0003724 | 22 Jul 2025 | 366.00 | NORTHSTAR MUTUAL | Not denied | — |