ZARA DIAZ
Dependent on policy B04M000036
Claims
3
Attributed to this person
Charged
846.00
Total submitted
Denied
687.05
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 | ZARA DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000036 |
| Date of birth | 24 Aug 1982 |
| Plan | BRONZE EPO |
| Covered from | 26 Jul 2024 |
| Covered to | 9 Mar 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000163 | 9 Jan 2025 | 112.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 32.05 |
| CLM0000164 | 12 Nov 2024 | 79.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000165 | 1 Jul 2024 | 655.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 655.00 |