HENRY DIAZ
Subscriber on policy B05M000803
Claims
3
Attributed to this person
Charged
1,521.00
Total submitted
Denied
326.00
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 | HENRY DIAZ |
| Role on the policy | Subscriber |
| Policy | B05M000803 |
| Date of birth | 24 Jun 1996 |
| Plan | BRONZE EPO |
| Covered from | 6 Jan 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 |
|---|---|---|---|---|---|
| CLM0003403 | 21 Dec 2024 | 326.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 326.00 |
| CLM0003402 | 6 Sep 2024 | 603.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003404 | 15 Apr 2024 | 592.00 | NORTHSTAR MUTUAL | Not denied | — |