ELENA DIAZ
Dependent on policy B03M000669
Claims
2
Attributed to this person
Charged
746.00
Total submitted
Denied
746.00
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 | ELENA DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B03M000669 |
| Date of birth | 15 Feb 1997 |
| Plan | SILVER HMO |
| Covered from | 14 Jan 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 |
|---|---|---|---|---|---|
| CLM0002771 | 9 Nov 2025 | 182.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 182.00 |
| CLM0002770 | 21 Dec 2024 | 564.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 564.00 |