BRIAN DIAZ
Subscriber on policy B03M000623
Claims
3
Attributed to this person
Charged
1,454.00
Total submitted
Denied
375.57
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 | BRIAN DIAZ |
| Role on the policy | Subscriber |
| Policy | B03M000623 |
| Date of birth | 16 May 2004 |
| Plan | GOLD PPO |
| Covered from | 10 Feb 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0002574 | 2 Dec 2025 | 562.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 273.57 |
| CLM0002573 | 19 Nov 2025 | 790.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002572 | 13 Nov 2024 | 102.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 102.00 |