LEILA TANAKA
Subscriber on policy B04M000327
Claims
3
Attributed to this person
Charged
1,880.00
Total submitted
Denied
464.88
3 denied claims
Patient responsibility
393.25
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 | LEILA TANAKA |
| Role on the policy | Subscriber |
| Policy | B04M000327 |
| Date of birth | 15 Dec 1999 |
| Plan | SILVER HMO |
| Covered from | 9 Apr 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 393.25 |
| Total | 393.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001418 | 11 Mar 2025 | 605.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0001419 | 24 Jan 2025 | 817.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 292.99 |
| CLM0001417 | 14 Jan 2025 | 458.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 171.89 |