JULIA DIAZ
Subscriber on policy B01M000238
Claims
3
Attributed to this person
Charged
1,861.00
Total submitted
Denied
105.81
2 denied claims
Patient responsibility
559.65
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 | JULIA DIAZ |
| Role on the policy | Subscriber |
| Policy | B01M000238 |
| Date of birth | 12 Jan 1960 |
| Plan | BRONZE EPO |
| Covered from | 16 Feb 2024 |
| Covered to | 21 Sep 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 559.65 |
| Total | 559.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001002 | 6 Aug 2024 | 711.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001003 | 23 Jul 2024 | 861.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001001 | 16 May 2024 | 289.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 105.81 |