IVAN BAKER
Subscriber on policy B05M000115
Claims
2
Attributed to this person
Charged
1,128.00
Total submitted
Denied
1,128.00
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 | IVAN BAKER |
| Role on the policy | Subscriber |
| Policy | B05M000115 |
| Date of birth | 12 Nov 1993 |
| Plan | BRONZE EPO |
| Covered from | 21 Jan 2025 |
| Covered to | 7 May 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 |
|---|---|---|---|---|---|
| CLM0000479 | 26 Jan 2025 | 724.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 724.00 |
| CLM0000478 | 24 Dec 2024 | 404.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 404.00 |