GRACE BAKER
Dependent on policy B06M000167
Claims
2
Attributed to this person
Charged
571.00
Total submitted
Denied
41.86
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 BAKER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000167 |
| Date of birth | 10 Jun 2015 |
| Plan | GOLD PPO |
| Covered from | 24 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 |
|---|---|---|---|---|---|
| CLM0000828 | 4 Feb 2026 | 120.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 41.86 |
| CLM0000829 | 28 Jun 2024 | 451.00 | NORTHSTAR MUTUAL | Not denied | — |