UMA DIAZ
Dependent on policy B08M000057
Claims
3
Attributed to this person
Charged
1,129.00
Total submitted
Denied
221.00
1 denied claims
Patient responsibility
83.10
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 19 |
| Policy | B08M000057 |
| Date of birth | 26 Nov 2014 |
| Plan | GOLD PPO |
| Covered from | 14 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 83.10 |
| Total | 83.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000260 | 5 Jan 2025 | 221.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 221.00 |
| CLM0000259 | 14 Nov 2024 | 354.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000261 | 3 Nov 2024 | 554.00 | MERIDIAN HEALTH PLAN | Not denied | — |