SOFIA DIAZ
Subscriber on policy B03M000714
Claims
2
Attributed to this person
Charged
889.00
Total submitted
Denied
357.47
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 | SOFIA DIAZ |
| Role on the policy | Subscriber |
| Policy | B03M000714 |
| Date of birth | 19 Oct 1972 |
| Plan | BRONZE EPO |
| Covered from | 20 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 |
|---|---|---|---|---|---|
| CLM0002985 | 11 Aug 2025 | 806.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 357.47 |
| CLM0002984 | 22 May 2025 | 83.00 | NORTHSTAR MUTUAL | Not denied | — |