TOMAS DIAZ
Subscriber on policy B04M000244
Claims
3
Attributed to this person
Charged
1,702.00
Total submitted
Denied
713.00
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 | TOMAS DIAZ |
| Role on the policy | Subscriber |
| Policy | B04M000244 |
| Date of birth | 7 Sep 1953 |
| Plan | BRONZE EPO |
| Covered from | 16 Jun 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 |
|---|---|---|---|---|---|
| CLM0001068 | 28 Jun 2026 | 179.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001066 | 12 Apr 2026 | 810.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001067 | 28 Oct 2025 | 713.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 713.00 |