GRACE DIAZ
Dependent on policy B06M000116
Claims
3
Attributed to this person
Charged
1,104.00
Total submitted
Denied
252.00
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 | GRACE DIAZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000116 |
| Date of birth | 30 Jul 1996 |
| Plan | GOLD PPO |
| Covered from | 30 Mar 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 |
|---|---|---|---|---|---|
| CLM0000576 | 18 Dec 2025 | 252.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 252.00 |
| CLM0000577 | 13 Apr 2024 | 782.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000575 | 2 Apr 2024 | 70.00 | MERIDIAN HEALTH PLAN | Not denied | — |