BRIAN BAKER
Dependent on policy B10M000747
Claims
3
Attributed to this person
Charged
1,742.00
Total submitted
Denied
971.00
2 denied claims
Patient responsibility
154.20
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 | BRIAN BAKER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000747 |
| Date of birth | 11 Oct 1975 |
| Plan | SILVER HMO |
| Covered from | 3 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 154.20 |
| Total | 154.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003138 | 4 Jul 2026 | 75.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 75.00 |
| CLM0003136 | 18 May 2025 | 896.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 896.00 |
| CLM0003137 | 4 Sep 2024 | 771.00 | NORTHSTAR MUTUAL | Not denied | — |