UMA TANAKA
Dependent on policy B04M000530
Claims
3
Attributed to this person
Charged
1,791.00
Total submitted
Denied
370.00
1 denied claims
Patient responsibility
20.00
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 | UMA TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000530 |
| Date of birth | 3 Jun 1992 |
| Plan | GOLD PPO |
| Covered from | 22 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 20.00 |
| Total | 20.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002313 | 9 Jan 2026 | 836.00 | CASCADE CARE | Not denied | — |
| CLM0002314 | 8 Oct 2025 | 370.00 | CASCADE CARE | CARC 18 · DUPLICATE | 370.00 |
| CLM0002312 | 29 Jul 2025 | 585.00 | CASCADE CARE | Not denied | — |