ELENA YAMADA
Dependent on policy B10M000001
Claims
2
Attributed to this person
Charged
975.00
Total submitted
Denied
17.16
2 denied claims
Patient responsibility
225.55
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 | ELENA YAMADA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000001 |
| Date of birth | 14 Aug 1944 |
| Plan | GOLD PPO |
| Covered from | 4 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 225.55 |
| Total | 225.55 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000013 | 12 Jul 2026 | 628.00 | NORTHSTAR MUTUAL | CARC 197 · AUTHORIZATION | 17.16 |
| CLM0000014 | 16 Apr 2026 | 347.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |