GRACE BAKER
Dependent on policy B03M000002
Claims
3
Attributed to this person
Charged
1,360.00
Total submitted
Denied
766.00
2 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 | GRACE BAKER |
| Role on the policy | Dependent · relationship 19 |
| Policy | B03M000002 |
| Date of birth | 4 Aug 1994 |
| Plan | PLATINUM PPO |
| Covered from | 1 Jan 2024 |
| Covered to | 27 May 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 |
|---|---|---|---|---|---|
| CLM0000012 | 29 Mar 2024 | 594.00 | CASCADE CARE | Not denied | — |
| CLM0000011 | 14 Feb 2024 | 514.00 | CASCADE CARE | CARC 16 · BILLING_ERROR | 514.00 |
| CLM0000010 | 12 Dec 2023 | 252.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 252.00 |