JULIA TANAKA
Subscriber on policy B04M000341
Claims
1
Attributed to this person
Charged
650.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
422.50
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 | JULIA TANAKA |
| Role on the policy | Subscriber |
| Policy | B04M000341 |
| Date of birth | 10 Jul 1961 |
| Plan | SILVER HMO |
| Covered from | 17 Jun 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 422.50 |
| Total | 422.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001474 | 15 Dec 2025 | 650.00 | MERIDIAN HEALTH PLAN | CARC 96 · NON_COVERED | 0.00 |