ELENA TANAKA
Dependent on policy B10M000396
Claims
3
Attributed to this person
Charged
1,674.00
Total submitted
Denied
202.28
1 denied claims
Patient responsibility
104.10
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 | ELENA TANAKA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000396 |
| Date of birth | 28 Jun 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 | 104.10 |
| Total | 104.10 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001645 | 5 Jan 2026 | 694.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001644 | 27 Aug 2025 | 586.00 | NORTHSTAR MUTUAL | CARC 18 · DUPLICATE | 202.28 |
| CLM0001646 | 19 Nov 2024 | 394.00 | NORTHSTAR MUTUAL | Not denied | — |