GRACE BAKER
Dependent on policy B05M000188
Claims
1
Attributed to this person
Charged
757.00
Total submitted
Denied
757.00
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 19 |
| Policy | B05M000188 |
| Date of birth | 23 Jan 1995 |
| Plan | BRONZE EPO |
| Covered from | 21 Apr 2024 |
| Covered to | 9 Aug 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000790 | 9 Sep 2024 | 757.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 757.00 |