AMARA DIAZ
Subscriber on policy B08M000490
Claims
2
Attributed to this person
Charged
1,551.00
Total submitted
Denied
666.00
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 | AMARA DIAZ |
| Role on the policy | Subscriber |
| Policy | B08M000490 |
| Date of birth | 12 May 1973 |
| Plan | GOLD PPO |
| Covered from | 15 Jan 2024 |
| Covered to | 26 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 |
|---|---|---|---|---|---|
| CLM0002267 | 3 Sep 2024 | 666.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 666.00 |
| CLM0002268 | 8 Jul 2024 | 885.00 | NORTHSTAR MUTUAL | Not denied | — |