KEVIN DIAZ
Dependent on policy B08M000715
Claims
3
Attributed to this person
Charged
1,190.00
Total submitted
Denied
853.62
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 | KEVIN DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000715 |
| Date of birth | 22 Nov 2023 |
| Plan | SILVER HMO |
| Covered from | 20 Apr 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0003213 | 24 Oct 2025 | 78.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 30.62 |
| CLM0003212 | 13 Mar 2025 | 823.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 823.00 |
| CLM0003214 | 21 Sep 2024 | 289.00 | NORTHSTAR MUTUAL | Not denied | — |