WENDY DIAZ
Subscriber on policy B10M000408
Claims
2
Attributed to this person
Charged
893.00
Total submitted
Denied
893.00
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 | WENDY DIAZ |
| Role on the policy | Subscriber |
| Policy | B10M000408 |
| Date of birth | 4 Aug 1975 |
| Plan | GOLD PPO |
| Covered from | 16 Nov 2024 |
| Covered to | 28 Apr 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001694 | 15 Apr 2025 | 797.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 797.00 |
| CLM0001693 | 19 Nov 2024 | 96.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 96.00 |