DAVID DIAZ
Subscriber on policy B05M000676
Claims
2
Attributed to this person
Charged
505.00
Total submitted
Denied
505.00
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 | B05M000676 |
| Date of birth | 13 Jan 2001 |
| Plan | GOLD PPO |
| Covered from | 27 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 |
|---|---|---|---|---|---|
| CLM0002912 | 22 Jun 2026 | 79.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 79.00 |
| CLM0002911 | 30 Aug 2025 | 426.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 426.00 |