GRACE BAKER
Dependent on policy B04M000666
Claims
3
Attributed to this person
Charged
1,435.00
Total submitted
Denied
552.00
1 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 01 |
| Policy | B04M000666 |
| Date of birth | 7 Jun 1979 |
| Plan | GOLD PPO |
| Covered from | 6 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002902 | 16 Oct 2025 | 552.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 552.00 |
| CLM0002903 | 12 Aug 2025 | 648.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002904 | 30 Dec 2024 | 235.00 | NORTHSTAR MUTUAL | Not denied | — |