RAVI TANAKA
Dependent on policy B01M000880
Claims
3
Attributed to this person
Charged
1,768.00
Total submitted
Denied
868.00
3 denied claims
Patient responsibility
585.00
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 | RAVI TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B01M000880 |
| Date of birth | 25 Jan 1995 |
| Plan | GOLD PPO |
| Covered from | 26 Oct 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 585.00 |
| Total | 585.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003898 | 23 May 2025 | 348.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 348.00 |
| CLM0003899 | 26 Jan 2025 | 900.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |
| CLM0003900 | 27 Sep 2024 | 520.00 | MERIDIAN HEALTH PLAN | CARC 26 · ELIGIBILITY | 520.00 |