OMAR TANAKA
Dependent on policy B08M000603
Claims
2
Attributed to this person
Charged
1,075.00
Total submitted
Denied
758.00
1 denied claims
Patient responsibility
47.55
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 | Dependent · relationship 01 |
| Policy | B08M000603 |
| Date of birth | 12 Feb 1960 |
| Plan | BRONZE EPO |
| Covered from | 17 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 47.55 |
| Total | 47.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002745 | 11 Jun 2026 | 317.00 | CASCADE CARE | Not denied | — |
| CLM0002744 | 5 May 2026 | 758.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 758.00 |