GRACE DIAZ
Dependent on policy B10M000051
Claims
3
Attributed to this person
Charged
1,138.00
Total submitted
Denied
276.62
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 | GRACE DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000051 |
| Date of birth | 27 Feb 2006 |
| 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 |
|---|---|---|---|---|---|
| CLM0000203 | 20 Aug 2026 | 227.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000202 | 22 Jul 2026 | 765.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 207.24 |
| CLM0000204 | 24 Jun 2025 | 146.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 69.38 |