MARCUS TANAKA
Dependent on policy B04M000116
Claims
3
Attributed to this person
Charged
1,522.00
Total submitted
Denied
655.19
2 denied claims
Patient responsibility
0.00
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 | MARCUS TANAKA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B04M000116 |
| Date of birth | 16 Sep 1997 |
| Plan | GOLD PPO |
| Covered from | 19 Apr 2025 |
| Covered to | 27 Jul 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000540 | 10 May 2025 | 681.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 6.19 |
| CLM0000541 | 8 May 2025 | 192.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000539 | 25 Mar 2025 | 649.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 649.00 |