VICTOR TANAKA
Subscriber on policy B06M000564
Claims
3
Attributed to this person
Charged
595.00
Total submitted
Denied
31.67
3 denied claims
Patient responsibility
328.25
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 | VICTOR TANAKA |
| Role on the policy | Subscriber |
| Policy | B06M000564 |
| Date of birth | 22 Oct 2003 |
| Plan | GOLD PPO |
| Covered from | 15 Feb 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 236.60 |
| CARC 96 · Other | 1 | 91.65 |
| Total | 328.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002518 | 6 Jul 2026 | 90.00 | MERIDIAN HEALTH PLAN | CARC 197 · AUTHORIZATION | 31.67 |
| CLM0002516 | 14 Apr 2026 | 141.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |
| CLM0002517 | 2 Mar 2025 | 364.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |