OMAR TANAKA
Subscriber on policy B08M000091
Claims
1
Attributed to this person
Charged
585.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
117.00
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 | OMAR TANAKA |
| Role on the policy | Subscriber |
| Policy | B08M000091 |
| Date of birth | 17 Dec 1984 |
| Plan | GOLD PPO |
| Covered from | 14 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 117.00 |
| Total | 117.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000404 | 27 May 2024 | 585.00 | NORTHSTAR MUTUAL | Not denied | — |