PRIYA BAKER
Subscriber on policy B04M000666
Claims
3
Attributed to this person
Charged
945.00
Total submitted
Denied
349.00
1 denied claims
Patient responsibility
30.00
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 | PRIYA BAKER |
| Role on the policy | Subscriber |
| Policy | B04M000666 |
| Date of birth | 23 Jun 1973 |
| Plan | GOLD PPO |
| Covered from | 6 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002900 | 21 Dec 2025 | 114.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002899 | 31 Aug 2025 | 482.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002901 | 23 Apr 2025 | 349.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 349.00 |