MARCUS DIAZ
Subscriber on policy B04M000231
Claims
3
Attributed to this person
Charged
938.00
Total submitted
Denied
87.00
1 denied claims
Patient responsibility
25.00
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 | MARCUS DIAZ |
| Role on the policy | Subscriber |
| Policy | B04M000231 |
| Date of birth | 10 Apr 2003 |
| Plan | GOLD PPO |
| Covered from | 21 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001013 | 10 Aug 2024 | 150.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001012 | 2 May 2024 | 701.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001011 | 9 Mar 2024 | 87.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 87.00 |