DAVID BAKER
Subscriber on policy B08M000832
Claims
2
Attributed to this person
Charged
1,278.00
Total submitted
Denied
111.91
2 denied claims
Patient responsibility
518.05
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 | DAVID BAKER |
| Role on the policy | Subscriber |
| Policy | B08M000832 |
| Date of birth | 30 Dec 1975 |
| Plan | BRONZE EPO |
| Covered from | 7 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 518.05 |
| Total | 518.05 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003712 | 9 Feb 2026 | 797.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0003711 | 7 Feb 2026 | 481.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 111.91 |