TOMAS TANAKA
Dependent on policy B04M000371
Claims
1
Attributed to this person
Charged
126.00
Total submitted
Denied
51.44
1 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 | TOMAS TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000371 |
| Date of birth | 25 Jun 2012 |
| Plan | GOLD PPO |
| Covered from | 13 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001594 | 11 Mar 2026 | 126.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 51.44 |