OMAR DIAZ
Subscriber on policy B01M000547
Claims
1
Attributed to this person
Charged
86.00
Total submitted
Denied
37.43
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 | OMAR DIAZ |
| Role on the policy | Subscriber |
| Policy | B01M000547 |
| Date of birth | 25 Sep 2001 |
| Plan | GOLD PPO |
| Covered from | 17 Aug 2024 |
| Covered to | 26 Dec 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002456 | 28 Aug 2024 | 86.00 | MERIDIAN HEALTH PLAN | CARC 109 · COB | 37.43 |