ZARA BAKER
Dependent on policy B08M000372
Claims
3
Attributed to this person
Charged
1,148.00
Total submitted
Denied
1,085.00
3 denied claims
Patient responsibility
40.95
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 BAKER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B08M000372 |
| Date of birth | 19 Jun 2005 |
| Plan | PLATINUM PPO |
| Covered from | 27 May 2024 |
| Covered to | 7 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 40.95 |
| Total | 40.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001698 | 20 Oct 2024 | 63.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0001700 | 18 Jul 2024 | 572.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 572.00 |
| CLM0001699 | 6 May 2024 | 513.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 513.00 |