KEVIN DIAZ
Dependent on policy B07M000173
Claims
3
Attributed to this person
Charged
1,102.00
Total submitted
Denied
724.20
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 | KEVIN DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B07M000173 |
| Date of birth | 11 Jan 2007 |
| Plan | PLATINUM PPO |
| Covered from | 24 Jun 2024 |
| Covered to | 23 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 |
|---|---|---|---|---|---|
| CLM0000699 | 19 Dec 2024 | 77.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 77.00 |
| CLM0000698 | 17 Nov 2024 | 484.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 484.00 |
| CLM0000700 | 5 Jul 2024 | 541.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 163.20 |