VICTOR DIAZ
Dependent on policy B05M000308
Claims
3
Attributed to this person
Charged
1,397.00
Total submitted
Denied
224.00
1 denied claims
Patient responsibility
126.90
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 | VICTOR DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000308 |
| Date of birth | 28 Aug 1960 |
| Plan | PLATINUM PPO |
| Covered from | 21 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 126.90 |
| Total | 126.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001282 | 22 Aug 2025 | 224.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 224.00 |
| CLM0001281 | 1 Oct 2024 | 846.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001283 | 2 Feb 2024 | 327.00 | NORTHSTAR MUTUAL | Not denied | — |