ZARA TANAKA
Subscriber on policy B01M000133
Claims
2
Attributed to this person
Charged
1,006.00
Total submitted
Denied
0.00
0 denied claims
Patient responsibility
110.20
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 | ZARA TANAKA |
| Role on the policy | Subscriber |
| Policy | B01M000133 |
| Date of birth | 24 May 1998 |
| Plan | SILVER HMO |
| Covered from | 29 May 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 110.20 |
| Total | 110.20 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000542 | 26 Dec 2024 | 551.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0000541 | 23 Dec 2024 | 455.00 | NORTHSTAR MUTUAL | Not denied | — |