BRIAN DIAZ
Dependent on policy B04M000516
Claims
2
Attributed to this person
Charged
305.00
Total submitted
Denied
120.00
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 | BRIAN DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000516 |
| Date of birth | 22 Nov 1996 |
| Plan | SILVER HMO |
| Covered from | 10 Feb 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 |
|---|---|---|---|---|---|
| CLM0002233 | 2 Aug 2026 | 120.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 120.00 |
| CLM0002232 | 5 Aug 2025 | 185.00 | NORTHSTAR MUTUAL | Not denied | — |