DAVID DIAZ
Subscriber on policy B05M000308
Claims
3
Attributed to this person
Charged
750.00
Total submitted
Denied
204.00
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 | DAVID DIAZ |
| Role on the policy | Subscriber |
| Policy | B05M000308 |
| Date of birth | 18 Sep 1966 |
| Plan | PLATINUM PPO |
| Covered from | 21 Jan 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 |
|---|---|---|---|---|---|
| CLM0001280 | 31 Oct 2025 | 126.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 126.00 |
| CLM0001278 | 18 Oct 2024 | 78.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 78.00 |
| CLM0001279 | 23 Sep 2024 | 546.00 | NORTHSTAR MUTUAL | Not denied | — |