IVAN DIAZ
Dependent on policy B05M000377
Claims
1
Attributed to this person
Charged
534.00
Total submitted
Denied
228.58
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 | B05M000377 |
| Date of birth | 31 Jan 1962 |
| Plan | PLATINUM PPO |
| Covered from | 30 Dec 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 |
|---|---|---|---|---|---|
| CLM0001602 | 29 Dec 2025 | 534.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 228.58 |