GRACE DIAZ
Subscriber on policy B10M000243
Claims
3
Attributed to this person
Charged
750.00
Total submitted
Denied
557.00
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 | Subscriber |
| Policy | B10M000243 |
| Date of birth | 12 Feb 1987 |
| Plan | GOLD PPO |
| Covered from | 18 Jan 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 |
|---|---|---|---|---|---|
| CLM0000993 | 8 Aug 2025 | 193.00 | CASCADE CARE | Not denied | — |
| CLM0000994 | 2 May 2025 | 172.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 172.00 |
| CLM0000995 | 12 May 2024 | 385.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 385.00 |