DAVID TANAKA
Dependent on policy B02M000288
Claims
2
Attributed to this person
Charged
1,559.00
Total submitted
Denied
334.22
1 denied claims
Patient responsibility
145.00
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 | DAVID TANAKA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B02M000288 |
| Date of birth | 12 Sep 1993 |
| Plan | SILVER HMO |
| Covered from | 3 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 145.00 |
| Total | 145.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001236 | 7 Feb 2025 | 834.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 334.22 |
| CLM0001235 | 26 Oct 2024 | 725.00 | NORTHSTAR MUTUAL | Not denied | — |