GRACE DIAZ
Dependent on policy B09M000259
Claims
3
Attributed to this person
Charged
1,004.00
Total submitted
Denied
735.00
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 | GRACE DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000259 |
| Date of birth | 9 Mar 1974 |
| Plan | BRONZE EPO |
| Covered from | 19 May 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 |
|---|---|---|---|---|---|
| CLM0001061 | 6 Oct 2025 | 514.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 514.00 |
| CLM0001060 | 28 Jan 2025 | 269.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001059 | 30 Jun 2024 | 221.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 221.00 |