TOMAS BAKER
Subscriber on policy B09M000043
Claims
3
Attributed to this person
Charged
878.00
Total submitted
Denied
878.00
3 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 | TOMAS BAKER |
| Role on the policy | Subscriber |
| Policy | B09M000043 |
| Date of birth | 4 May 1954 |
| Plan | SILVER HMO |
| Covered from | 28 Feb 2024 |
| Covered to | 1 Dec 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000202 | 19 Dec 2024 | 482.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 482.00 |
| CLM0000201 | 30 Oct 2024 | 305.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 305.00 |
| CLM0000203 | 5 Oct 2024 | 91.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 91.00 |