OMAR DIAZ
Subscriber on policy B05M000029
Claims
3
Attributed to this person
Charged
1,794.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
50.00
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 | OMAR DIAZ |
| Role on the policy | Subscriber |
| Policy | B05M000029 |
| Date of birth | 25 Mar 1961 |
| Plan | SILVER HMO |
| Covered from | 9 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000132 | 17 May 2026 | 684.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000131 | 3 May 2026 | 817.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000133 | 5 Sep 2025 | 293.00 | MERIDIAN HEALTH PLAN | Not denied | — |