HENRY DIAZ
Dependent on policy B09M000385
Claims
2
Attributed to this person
Charged
1,417.00
Total submitted
Denied
1,417.00
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 | HENRY DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000385 |
| Date of birth | 24 May 1968 |
| Plan | BRONZE EPO |
| Covered from | 27 Mar 2024 |
| Covered to | 9 Jul 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 |
|---|---|---|---|---|---|
| CLM0001602 | 21 Jun 2024 | 768.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 768.00 |
| CLM0001603 | 7 Mar 2024 | 649.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 649.00 |