OMAR BAKER
Dependent on policy B09M000800
Claims
2
Attributed to this person
Charged
830.00
Total submitted
Denied
137.00
1 denied claims
Patient responsibility
138.60
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 | OMAR BAKER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B09M000800 |
| Date of birth | 7 Apr 2023 |
| Plan | BRONZE EPO |
| Covered from | 8 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 138.60 |
| Total | 138.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003400 | 28 Mar 2025 | 693.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003401 | 25 Feb 2025 | 137.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 137.00 |