KEVIN TANAKA
Subscriber on policy B08M000024
Claims
3
Attributed to this person
Charged
1,421.00
Total submitted
Denied
568.00
2 denied claims
Patient responsibility
127.95
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 | KEVIN TANAKA |
| Role on the policy | Subscriber |
| Policy | B08M000024 |
| Date of birth | 12 Jun 2000 |
| Plan | GOLD PPO |
| Covered from | 15 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 127.95 |
| Total | 127.95 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000108 | 24 May 2026 | 270.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 270.00 |
| CLM0000109 | 4 Oct 2025 | 853.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000107 | 26 Nov 2024 | 298.00 | NORTHSTAR MUTUAL | CARC 109 · COB | 298.00 |