GRACE TANAKA
Dependent on policy B04M000490
Claims
3
Attributed to this person
Charged
1,072.00
Total submitted
Denied
362.18
3 denied claims
Patient responsibility
208.65
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 | Dependent · relationship 19 |
| Policy | B04M000490 |
| Date of birth | 26 Aug 2013 |
| Plan | SILVER HMO |
| Covered from | 13 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 208.65 |
| Total | 208.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002102 | 1 Jan 2026 | 88.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 88.00 |
| CLM0002101 | 12 Nov 2025 | 321.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0002100 | 21 Aug 2024 | 663.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 274.18 |