GRACE BAKER
Dependent on policy B06M000167
Claims
3
Attributed to this person
Charged
1,665.00
Total submitted
Denied
66.21
2 denied claims
Patient responsibility
317.20
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 BAKER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000167 |
| Date of birth | 9 Jul 2004 |
| Plan | GOLD PPO |
| Covered from | 24 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 317.20 |
| Total | 317.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000827 | 14 Jun 2026 | 848.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000825 | 13 May 2026 | 329.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 66.21 |
| CLM0000826 | 13 Dec 2024 | 488.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |