PRIYA DIAZ
Dependent on policy B09M000253
Claims
1
Attributed to this person
Charged
757.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
492.05
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 | PRIYA DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000253 |
| Date of birth | 28 Apr 1970 |
| Plan | PLATINUM PPO |
| Covered from | 19 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 492.05 |
| Total | 492.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001020 | 26 Aug 2025 | 757.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |