MARCUS DIAZ
Dependent on policy B02M000728
Claims
3
Attributed to this person
Charged
701.00
Total submitted
Denied
243.00
2 denied claims
Patient responsibility
98.15
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 | MARCUS DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B02M000728 |
| Date of birth | 8 Feb 2008 |
| Plan | BRONZE EPO |
| Covered from | 13 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 98.15 |
| Total | 98.15 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003052 | 19 Aug 2025 | 243.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 243.00 |
| CLM0003054 | 23 May 2025 | 307.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003053 | 25 Dec 2024 | 151.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |