IVAN DIAZ
Dependent on policy B05M000343
Claims
2
Attributed to this person
Charged
635.00
Total submitted
Denied
111.00
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 | IVAN DIAZ |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000343 |
| Date of birth | 9 Sep 1955 |
| Plan | PLATINUM PPO |
| Covered from | 2 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 |
|---|---|---|---|---|---|
| CLM0001467 | 25 Sep 2025 | 111.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 111.00 |
| CLM0001466 | 21 Jul 2024 | 524.00 | NORTHSTAR MUTUAL | Not denied | — |