GRACE DIAZ
Dependent on policy B07M000160
Claims
3
Attributed to this person
Charged
739.00
Total submitted
Denied
739.00
3 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 | GRACE DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B07M000160 |
| Date of birth | 31 Aug 1993 |
| Plan | GOLD PPO |
| Covered from | 24 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000654 | 25 Aug 2025 | 437.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 437.00 |
| CLM0000653 | 23 Jun 2025 | 71.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 71.00 |
| CLM0000655 | 15 Apr 2025 | 231.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 231.00 |