OMAR DIAZ
Subscriber on policy B02M000236
Claims
3
Attributed to this person
Charged
1,229.00
Total submitted
Denied
152.27
1 denied claims
Patient responsibility
20.00
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 | Subscriber |
| Policy | B02M000236 |
| Date of birth | 29 Aug 1987 |
| Plan | BRONZE EPO |
| Covered from | 14 Jul 2024 |
| Covered to | 16 Apr 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001030 | 18 Jan 2025 | 484.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 152.27 |
| CLM0001032 | 12 Dec 2024 | 438.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0001031 | 27 Nov 2024 | 307.00 | MERIDIAN HEALTH PLAN | Not denied | — |