PRIYA TANAKA
Dependent on policy B04M000011
Claims
2
Attributed to this person
Charged
1,063.00
Total submitted
Denied
123.75
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 | PRIYA TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000011 |
| Date of birth | 8 Sep 2006 |
| Plan | BRONZE EPO |
| Covered from | 23 Feb 2025 |
| Covered to | 11 Sep 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 |
|---|---|---|---|---|---|
| CLM0000056 | 23 Apr 2025 | 288.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 123.75 |
| CLM0000057 | 1 Apr 2025 | 775.00 | CASCADE CARE | Not denied | — |