ELENA TANAKA
Subscriber on policy B04M000544
Claims
3
Attributed to this person
Charged
1,852.00
Total submitted
Denied
896.00
2 denied claims
Patient responsibility
395.85
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 | ELENA TANAKA |
| Role on the policy | Subscriber |
| Policy | B04M000544 |
| Date of birth | 16 Jul 1979 |
| Plan | SILVER HMO |
| Covered from | 14 Sep 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 395.85 |
| Total | 395.85 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002391 | 28 Dec 2025 | 347.00 | CASCADE CARE | Not denied | — |
| CLM0002392 | 12 Oct 2025 | 609.00 | CASCADE CARE | CARC 96 · NON_COVERED | 0.00 |
| CLM0002390 | 8 May 2025 | 896.00 | CASCADE CARE | CARC 197 · AUTHORIZATION | 896.00 |