SOFIA TANAKA
Dependent on policy B07M000332
Claims
3
Attributed to this person
Charged
1,397.00
Total submitted
Denied
111.33
1 denied claims
Patient responsibility
50.00
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 01 |
| Policy | B07M000332 |
| Date of birth | 5 Feb 1954 |
| Plan | SILVER HMO |
| Covered from | 18 Jan 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001413 | 12 Aug 2025 | 441.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001415 | 23 May 2024 | 453.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 111.33 |
| CLM0001414 | 7 Apr 2024 | 503.00 | NORTHSTAR MUTUAL | Not denied | — |