GRACE DIAZ
Dependent on policy B07M000706
Claims
2
Attributed to this person
Charged
491.00
Total submitted
Denied
491.00
2 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 | B07M000706 |
| Date of birth | 4 Jul 2022 |
| Plan | SILVER HMO |
| Covered from | 4 May 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 |
|---|---|---|---|---|---|
| CLM0002921 | 6 Dec 2025 | 136.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 136.00 |
| CLM0002920 | 20 May 2025 | 355.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 355.00 |