TOMAS DIAZ
Dependent on policy B01M000111
Claims
3
Attributed to this person
Charged
1,449.00
Total submitted
Denied
1,319.00
2 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 | Dependent · relationship 19 |
| Policy | B01M000111 |
| Date of birth | 6 Oct 2001 |
| Plan | PLATINUM PPO |
| Covered from | 4 May 2024 |
| Covered to | 7 Oct 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000444 | 26 Oct 2024 | 473.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 473.00 |
| CLM0000445 | 18 May 2024 | 130.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000443 | 9 May 2024 | 846.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 846.00 |