SOFIA TANAKA
Subscriber on policy B09M000812
Claims
2
Attributed to this person
Charged
1,271.00
Total submitted
Denied
590.00
1 denied claims
Patient responsibility
0.00
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 | SOFIA TANAKA |
| Role on the policy | Subscriber |
| Policy | B09M000812 |
| Date of birth | 26 Jul 1960 |
| Plan | SILVER HMO |
| Covered from | 5 Jul 2024 |
| Covered to | 10 Feb 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003448 | 12 Feb 2025 | 590.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 590.00 |
| CLM0003449 | 18 Oct 2024 | 681.00 | NORTHSTAR MUTUAL | Not denied | — |