PRIYA TANAKA
Subscriber on policy B08M000500
Claims
2
Attributed to this person
Charged
960.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
25.00
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 | PRIYA TANAKA |
| Role on the policy | Subscriber |
| Policy | B08M000500 |
| Date of birth | 25 May 1994 |
| Plan | PLATINUM PPO |
| Covered from | 12 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 25.00 |
| Total | 25.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002306 | 15 Jul 2026 | 500.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002307 | 27 Mar 2025 | 460.00 | NORTHSTAR MUTUAL | Not denied | — |