PRIYA TANAKA
Subscriber on policy B03M000023
Claims
2
Attributed to this person
Charged
1,411.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
111.00
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 | PRIYA TANAKA |
| Role on the policy | Subscriber |
| Policy | B03M000023 |
| Date of birth | 14 May 1995 |
| Plan | PLATINUM PPO |
| Covered from | 25 Dec 2024 |
| Covered to | 12 Jun 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 111.00 |
| Total | 111.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000106 | 20 Jun 2025 | 740.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000105 | 19 May 2025 | 671.00 | NORTHSTAR MUTUAL | Not denied | — |