AMARA BAKER
Dependent on policy B04M000166
Claims
2
Attributed to this person
Charged
694.00
Total submitted
Denied
398.23
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 | AMARA BAKER |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000166 |
| Date of birth | 4 Feb 1950 |
| Plan | SILVER HMO |
| Covered from | 23 Nov 2024 |
| Covered to | 6 Aug 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000758 | 16 Jun 2025 | 374.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 78.23 |
| CLM0000759 | 4 Apr 2025 | 320.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 320.00 |