HENRY TANAKA
Subscriber on policy B02M000402
Claims
2
Attributed to this person
Charged
1,157.00
Total submitted
Denied
1,020.96
2 denied claims
Patient responsibility
0.00
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 | HENRY TANAKA |
| Role on the policy | Subscriber |
| Policy | B02M000402 |
| Date of birth | 3 May 2002 |
| Plan | BRONZE EPO |
| Covered from | 17 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001723 | 5 Aug 2024 | 265.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 128.96 |
| CLM0001724 | 1 Jun 2024 | 892.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 892.00 |