GRACE BAKER
Subscriber on policy B05M000450
Claims
3
Attributed to this person
Charged
1,014.00
Total submitted
Denied
640.00
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 | Subscriber |
| Policy | B05M000450 |
| Date of birth | 7 Nov 1988 |
| Plan | BRONZE EPO |
| Covered from | 22 Jun 2024 |
| Covered to | 4 Nov 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 |
|---|---|---|---|---|---|
| CLM0001888 | 5 Nov 2024 | 640.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 640.00 |
| CLM0001887 | 30 Oct 2024 | 162.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001889 | 24 Aug 2024 | 212.00 | NORTHSTAR MUTUAL | Not denied | — |