CARLA DIAZ
Subscriber on policy B05M000097
Claims
1
Attributed to this person
Charged
215.00
Total submitted
Denied
13.04
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 | CARLA DIAZ |
| Role on the policy | Subscriber |
| Policy | B05M000097 |
| Date of birth | 17 Nov 1988 |
| Plan | GOLD PPO |
| Covered from | 11 Jun 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 |
|---|---|---|---|---|---|
| CLM0000430 | 6 Jan 2025 | 215.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 13.04 |