GRACE TANAKA
Subscriber on policy B09M000444
Claims
3
Attributed to this person
Charged
1,730.00
Total submitted
Denied
673.00
2 denied claims
Patient responsibility
40.00
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 | GRACE TANAKA |
| Role on the policy | Subscriber |
| Policy | B09M000444 |
| Date of birth | 21 Dec 1981 |
| Plan | BRONZE EPO |
| Covered from | 29 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 40.00 |
| Total | 40.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001869 | 24 Mar 2026 | 494.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001867 | 12 Jun 2025 | 352.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 352.00 |
| CLM0001868 | 19 May 2024 | 884.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 321.00 |