WENDY TANAKA
Subscriber on policy B06M000578
Claims
3
Attributed to this person
Charged
1,692.00
Total submitted
Denied
634.00
1 denied claims
Patient responsibility
25.00
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 | WENDY TANAKA |
| Role on the policy | Subscriber |
| Policy | B06M000578 |
| Date of birth | 20 Mar 1987 |
| Plan | SILVER HMO |
| Covered from | 13 May 2024 |
| Covered to | 8 Aug 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002593 | 28 Aug 2024 | 634.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 634.00 |
| CLM0002592 | 5 Aug 2024 | 368.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002591 | 27 Jul 2024 | 690.00 | MERIDIAN HEALTH PLAN | Not denied | — |