OMAR DIAZ
Subscriber on policy B07M000596
Claims
1
Attributed to this person
Charged
84.00
Total submitted
Denied
84.00
1 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 | OMAR DIAZ |
| Role on the policy | Subscriber |
| Policy | B07M000596 |
| Date of birth | 2 May 1966 |
| Plan | PLATINUM PPO |
| Covered from | 13 Apr 2024 |
| Covered to | 14 Jun 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 |
|---|---|---|---|---|---|
| CLM0002503 | 25 Jul 2024 | 84.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 84.00 |