ZARA DIAZ
Subscriber on policy B04M000224
Claims
3
Attributed to this person
Charged
1,594.00
Total submitted
Denied
700.00
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 | ZARA DIAZ |
| Role on the policy | Subscriber |
| Policy | B04M000224 |
| Date of birth | 10 Oct 1967 |
| Plan | SILVER HMO |
| Covered from | 31 Jan 2025 |
| Covered to | 7 Apr 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 |
|---|---|---|---|---|---|
| CLM0000983 | 6 Jun 2025 | 426.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 426.00 |
| CLM0000984 | 29 Apr 2025 | 274.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 274.00 |
| CLM0000982 | 31 Jan 2025 | 894.00 | NORTHSTAR MUTUAL | Not denied | — |