MARCUS TANAKA
Dependent on policy B04M000371
Claims
2
Attributed to this person
Charged
1,021.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
317.85
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 | B04M000371 |
| Date of birth | 28 Sep 1981 |
| Plan | GOLD PPO |
| Covered from | 13 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 317.85 |
| Total | 317.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001588 | 22 Apr 2025 | 532.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001589 | 5 Jun 2024 | 489.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |