JULIA TANAKA
Dependent on policy B04M000798
Claims
2
Attributed to this person
Charged
332.00
Total submitted
Denied
246.00
1 denied claims
Patient responsibility
12.90
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 | JULIA TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000798 |
| Date of birth | 12 Sep 1991 |
| Plan | GOLD PPO |
| Covered from | 25 Jun 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 12.90 |
| Total | 12.90 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003486 | 30 Aug 2025 | 246.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 246.00 |
| CLM0003487 | 27 Sep 2024 | 86.00 | NORTHSTAR MUTUAL | Not denied | — |