PRIYA TANAKA
Dependent on policy B08M000828
Claims
2
Attributed to this person
Charged
828.00
Total submitted
Denied
637.00
1 denied claims
Patient responsibility
38.20
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 | Dependent · relationship 19 |
| Policy | B08M000828 |
| Date of birth | 28 Feb 2005 |
| Plan | SILVER HMO |
| Covered from | 28 Aug 2024 |
| Covered to | 6 Apr 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 38.20 |
| Total | 38.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003698 | 8 Apr 2025 | 637.00 | CASCADE CARE | CARC 27 · ELIGIBILITY | 637.00 |
| CLM0003697 | 2 Jan 2025 | 191.00 | CASCADE CARE | Not denied | — |