YUSUF TANAKA
Subscriber on policy B10M000396
Claims
3
Attributed to this person
Charged
1,331.00
Total submitted
Denied
442.00
1 denied claims
Patient responsibility
47.10
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 | YUSUF TANAKA |
| Role on the policy | Subscriber |
| Policy | B10M000396 |
| Date of birth | 11 Oct 1950 |
| Plan | PLATINUM PPO |
| Covered from | 23 Aug 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 47.10 |
| Total | 47.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001641 | 24 Sep 2025 | 314.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001643 | 30 May 2025 | 575.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001642 | 22 Oct 2024 | 442.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 442.00 |