JULIA BAKER
Subscriber on policy B04M000166
Claims
3
Attributed to this person
Charged
763.00
Total submitted
Denied
185.00
1 denied claims
Patient responsibility
12.00
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 | JULIA BAKER |
| Role on the policy | Subscriber |
| Policy | B04M000166 |
| Date of birth | 16 May 1959 |
| Plan | SILVER HMO |
| Covered from | 23 Nov 2024 |
| Covered to | 6 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 12.00 |
| Total | 12.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000755 | 16 Jul 2025 | 498.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000757 | 29 Apr 2025 | 80.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000756 | 6 Nov 2024 | 185.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 185.00 |