ZARA TANAKA
Subscriber on policy B01M000600
Claims
2
Attributed to this person
Charged
310.00
Total submitted
Denied
51.75
2 denied claims
Patient responsibility
47.45
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 | ZARA TANAKA |
| Role on the policy | Subscriber |
| Policy | B01M000600 |
| Date of birth | 23 Jun 1986 |
| Plan | SILVER HMO |
| Covered from | 5 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 47.45 |
| Total | 47.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002668 | 14 Sep 2025 | 237.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 51.75 |
| CLM0002667 | 19 May 2025 | 73.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |