AMARA DIAZ
Dependent on policy B02M000805
Claims
2
Attributed to this person
Charged
955.00
Total submitted
Denied
860.00
2 denied claims
Patient responsibility
61.75
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 | AMARA DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000805 |
| Date of birth | 14 Jun 1958 |
| Plan | SILVER HMO |
| Covered from | 7 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 61.75 |
| Total | 61.75 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003356 | 21 Mar 2026 | 95.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0003357 | 14 Apr 2025 | 860.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 860.00 |