AMARA DIAZ
Dependent on policy B03M000051
Claims
2
Attributed to this person
Charged
1,038.00
Total submitted
Denied
895.00
1 denied claims
Patient responsibility
21.45
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 | B03M000051 |
| Date of birth | 23 Nov 1949 |
| Plan | SILVER HMO |
| Covered from | 26 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 21.45 |
| Total | 21.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000221 | 25 Jul 2025 | 143.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000222 | 13 Jun 2025 | 895.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 895.00 |