PRIYA TANAKA
Dependent on policy B09M000310
Claims
2
Attributed to this person
Charged
466.00
Total submitted
Denied
347.00
1 denied claims
Patient responsibility
17.85
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 01 |
| Policy | B09M000310 |
| Date of birth | 30 Sep 2003 |
| Plan | GOLD PPO |
| Covered from | 3 Feb 2025 |
| Covered to | 19 Aug 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 17.85 |
| Total | 17.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001270 | 21 Jun 2025 | 119.00 | CASCADE CARE | Not denied | — |
| CLM0001271 | 22 Jan 2025 | 347.00 | CASCADE CARE | CARC 26 · ELIGIBILITY | 347.00 |