GRACE DIAZ
Dependent on policy B01M000036
Claims
3
Attributed to this person
Charged
1,361.00
Total submitted
Denied
352.48
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 | GRACE DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B01M000036 |
| Date of birth | 26 Feb 1966 |
| Plan | GOLD PPO |
| Covered from | 5 Apr 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 |
|---|---|---|---|---|---|
| CLM0000144 | 26 Apr 2026 | 87.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000145 | 30 Nov 2025 | 463.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000143 | 11 Sep 2025 | 811.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 352.48 |