OMAR TANAKA
Subscriber on policy B06M000217
Claims
2
Attributed to this person
Charged
1,207.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
378.95
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 | OMAR TANAKA |
| Role on the policy | Subscriber |
| Policy | B06M000217 |
| Date of birth | 31 Jul 1966 |
| Plan | SILVER HMO |
| Covered from | 31 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 378.95 |
| Total | 378.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001037 | 16 Oct 2025 | 583.00 | CASCADE CARE | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0001038 | 15 Aug 2025 | 624.00 | CASCADE CARE | Not denied | — |