SOFIA TANAKA
Dependent on policy B06M000715
Claims
2
Attributed to this person
Charged
1,195.00
Total submitted
Denied
601.00
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 | SOFIA TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B06M000715 |
| Date of birth | 8 Apr 2021 |
| Plan | PLATINUM PPO |
| Covered from | 1 Jun 2025 |
| Covered to | 5 Oct 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003200 | 25 Nov 2025 | 601.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 601.00 |
| CLM0003199 | 28 Aug 2025 | 594.00 | NORTHSTAR MUTUAL | Not denied | — |