PRIYA DIAZ
Subscriber on policy B05M000487
Claims
3
Attributed to this person
Charged
999.00
Total submitted
Denied
80.00
2 denied claims
Patient responsibility
155.35
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 | PRIYA DIAZ |
| Role on the policy | Subscriber |
| Policy | B05M000487 |
| Date of birth | 26 Oct 1958 |
| Plan | PLATINUM PPO |
| Covered from | 17 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 155.35 |
| Total | 155.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002068 | 21 Aug 2026 | 680.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002067 | 5 Mar 2025 | 80.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 80.00 |
| CLM0002069 | 20 Aug 2024 | 239.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |