ELENA TANAKA
Subscriber on policy B03M000506
Claims
3
Attributed to this person
Charged
900.00
Total submitted
Denied
89.00
1 denied claims
Patient responsibility
66.00
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 | ELENA TANAKA |
| Role on the policy | Subscriber |
| Policy | B03M000506 |
| Date of birth | 13 Mar 1968 |
| Plan | SILVER HMO |
| Covered from | 28 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 66.00 |
| Total | 66.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002087 | 19 Feb 2026 | 371.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0002089 | 16 Feb 2026 | 89.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 89.00 |
| CLM0002088 | 14 Apr 2024 | 440.00 | NORTHSTAR MUTUAL | Not denied | — |