SOFIA BAKER
Dependent on policy B09M000007
Claims
3
Attributed to this person
Charged
1,019.00
Total submitted
Denied
310.15
2 denied claims
Patient responsibility
104.80
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 | SOFIA BAKER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000007 |
| Date of birth | 5 Mar 1957 |
| Plan | GOLD PPO |
| Covered from | 7 Mar 2024 |
| Covered to | 28 Dec 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 104.80 |
| Total | 104.80 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000027 | 13 Feb 2025 | 524.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000026 | 15 Jan 2025 | 250.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 250.00 |
| CLM0000028 | 1 Oct 2024 | 245.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 60.15 |