UMA DIAZ
Dependent on policy B07M000572
Claims
2
Attributed to this person
Charged
1,397.00
Total submitted
Denied
514.00
1 denied claims
Patient responsibility
132.45
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 | UMA DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000572 |
| Date of birth | 8 Feb 1995 |
| Plan | SILVER HMO |
| Covered from | 18 Apr 2025 |
| Covered to | 17 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 132.45 |
| Total | 132.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002419 | 13 May 2025 | 883.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002418 | 9 Apr 2025 | 514.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 514.00 |