MARCUS DIAZ
Subscriber on policy B05M000720
Claims
3
Attributed to this person
Charged
1,670.00
Total submitted
Denied
632.00
2 denied claims
Patient responsibility
394.70
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 | MARCUS DIAZ |
| Role on the policy | Subscriber |
| Policy | B05M000720 |
| Date of birth | 14 May 1987 |
| Plan | GOLD PPO |
| Covered from | 2 Nov 2024 |
| Covered to | 11 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 310.70 |
| CARC 1 · Deductible | 1 | 84.00 |
| Total | 394.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003084 | 23 Jul 2025 | 632.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 632.00 |
| CLM0003085 | 17 May 2025 | 478.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0003083 | 15 Jan 2025 | 560.00 | NORTHSTAR MUTUAL | Not denied | — |