VICTOR DIAZ
Dependent on policy B08M000619
Claims
2
Attributed to this person
Charged
763.00
Total submitted
Denied
763.00
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 | VICTOR DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000619 |
| Date of birth | 13 Dec 2020 |
| Plan | GOLD PPO |
| Covered from | 4 May 2025 |
| Covered to | 3 Nov 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002823 | 10 Jul 2025 | 630.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 630.00 |
| CLM0002822 | 7 Jun 2025 | 133.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 133.00 |