NADIA TANAKA
Subscriber on policy B01M000545
Claims
2
Attributed to this person
Charged
383.00
Total submitted
Denied
181.00
2 denied claims
Patient responsibility
131.30
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 | NADIA TANAKA |
| Role on the policy | Subscriber |
| Policy | B01M000545 |
| Date of birth | 28 Feb 1975 |
| Plan | GOLD PPO |
| Covered from | 18 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 131.30 |
| Total | 131.30 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002450 | 5 Jan 2026 | 202.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0002449 | 8 Dec 2024 | 181.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 181.00 |