KEVIN DIAZ
Subscriber on policy B08M000571
Claims
2
Attributed to this person
Charged
503.00
Total submitted
Denied
324.18
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 | Subscriber |
| Policy | B08M000571 |
| Date of birth | 16 Mar 1992 |
| Plan | BRONZE EPO |
| Covered from | 29 Mar 2024 |
| Covered to | 8 Sep 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 |
|---|---|---|---|---|---|
| CLM0002613 | 6 Jul 2024 | 310.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 131.18 |
| CLM0002612 | 16 Mar 2024 | 193.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 193.00 |