GRACE TANAKA
Subscriber on policy B03M000266
Claims
3
Attributed to this person
Charged
962.00
Total submitted
Denied
123.31
1 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 | GRACE TANAKA |
| Role on the policy | Subscriber |
| Policy | B03M000266 |
| Date of birth | 9 Nov 1974 |
| Plan | BRONZE EPO |
| Covered from | 28 Feb 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 |
|---|---|---|---|---|---|
| CLM0001073 | 25 Feb 2026 | 613.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001074 | 30 Sep 2025 | 80.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001072 | 19 Aug 2025 | 269.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 123.31 |