DAVID TANAKA
Subscriber on policy B04M000421
Claims
2
Attributed to this person
Charged
860.00
Total submitted
Denied
357.00
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 | DAVID TANAKA |
| Role on the policy | Subscriber |
| Policy | B04M000421 |
| Date of birth | 11 May 1963 |
| Plan | PLATINUM PPO |
| Covered from | 19 Nov 2024 |
| Covered to | 3 May 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 |
|---|---|---|---|---|---|
| CLM0001813 | 9 Jun 2025 | 357.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 357.00 |
| CLM0001814 | 18 Apr 2025 | 503.00 | NORTHSTAR MUTUAL | Not denied | — |