OMAR DIAZ
Dependent on policy B03M000140
Claims
2
Attributed to this person
Charged
905.00
Total submitted
Denied
905.00
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 | OMAR DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000140 |
| Date of birth | 2 Oct 1997 |
| Plan | PLATINUM PPO |
| Covered from | 12 Jun 2025 |
| 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 |
|---|---|---|---|---|---|
| CLM0000573 | 9 Oct 2025 | 122.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 122.00 |
| CLM0000572 | 6 Aug 2025 | 783.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 783.00 |