CARLA TANAKA
Subscriber on policy B04M000832
Claims
3
Attributed to this person
Charged
1,479.00
Total submitted
Denied
662.00
1 denied claims
Patient responsibility
50.00
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 | CARLA TANAKA |
| Role on the policy | Subscriber |
| Policy | B04M000832 |
| Date of birth | 17 Nov 1962 |
| Plan | PLATINUM PPO |
| Covered from | 15 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 50.00 |
| Total | 50.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003600 | 16 Mar 2026 | 489.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003601 | 17 Jun 2025 | 328.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0003599 | 20 May 2024 | 662.00 | MERIDIAN HEALTH PLAN | CARC 16 · BILLING_ERROR | 662.00 |