RAVI DIAZ
Subscriber on policy B01M000100
Claims
3
Attributed to this person
Charged
796.00
Total submitted
Denied
539.00
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 | RAVI DIAZ |
| Role on the policy | Subscriber |
| Policy | B01M000100 |
| Date of birth | 12 May 1987 |
| Plan | PLATINUM PPO |
| Covered from | 15 Sep 2024 |
| 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 |
|---|---|---|---|---|---|
| CLM0000398 | 11 Mar 2026 | 94.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000399 | 20 Jan 2026 | 539.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 539.00 |
| CLM0000400 | 4 Oct 2025 | 163.00 | NORTHSTAR MUTUAL | Not denied | — |