JULIA TANAKA
Dependent on policy B09M000812
Claims
3
Attributed to this person
Charged
1,305.00
Total submitted
Denied
1,305.00
3 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 | JULIA TANAKA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B09M000812 |
| Date of birth | 15 Feb 1952 |
| 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 |
|---|---|---|---|---|---|
| CLM0003450 | 10 Feb 2025 | 121.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 121.00 |
| CLM0003451 | 31 Jul 2024 | 661.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 661.00 |
| CLM0003452 | 28 Jun 2024 | 523.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 523.00 |