WENDY DIAZ
Dependent on policy B02M000394
Claims
2
Attributed to this person
Charged
1,029.00
Total submitted
Denied
131.41
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 | WENDY DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000394 |
| Date of birth | 6 May 1972 |
| Plan | SILVER HMO |
| Covered from | 2 Mar 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 |
|---|---|---|---|---|---|
| CLM0001682 | 11 Apr 2025 | 272.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 131.41 |
| CLM0001681 | 15 Apr 2024 | 757.00 | NORTHSTAR MUTUAL | Not denied | — |