AMARA TANAKA
Subscriber on policy B06M000754
Claims
3
Attributed to this person
Charged
1,221.00
Total submitted
Denied
432.00
2 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 | AMARA TANAKA |
| Role on the policy | Subscriber |
| Policy | B06M000754 |
| Date of birth | 7 Dec 1961 |
| Plan | GOLD PPO |
| Covered from | 15 Sep 2024 |
| Covered to | 23 Jan 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 |
|---|---|---|---|---|---|
| CLM0003342 | 28 Dec 2024 | 789.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003343 | 11 Dec 2024 | 143.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 143.00 |
| CLM0003344 | 20 Aug 2024 | 289.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 289.00 |