OMAR DIAZ
Dependent on policy B10M000203
Claims
1
Attributed to this person
Charged
343.00
Total submitted
Denied
343.00
1 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 | OMAR DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B10M000203 |
| Date of birth | 29 May 2007 |
| Plan | PLATINUM PPO |
| Covered from | 15 Feb 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0000835 | 10 May 2025 | 343.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 343.00 |