ZARA DIAZ
Subscriber on policy B05M000793
Claims
3
Attributed to this person
Charged
1,023.00
Total submitted
Denied
392.00
2 denied claims
Patient responsibility
297.70
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 | ZARA DIAZ |
| Role on the policy | Subscriber |
| Policy | B05M000793 |
| Date of birth | 21 Sep 1972 |
| Plan | GOLD PPO |
| Covered from | 2 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 297.70 |
| Total | 297.70 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003361 | 6 Feb 2026 | 392.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 392.00 |
| CLM0003360 | 24 Jan 2026 | 458.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0003362 | 27 Sep 2025 | 173.00 | NORTHSTAR MUTUAL | Not denied | — |