OMAR TANAKA
Subscriber on policy B05M000050
Claims
2
Attributed to this person
Charged
265.00
Total submitted
Denied
196.00
1 denied claims
Patient responsibility
10.35
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 | OMAR TANAKA |
| Role on the policy | Subscriber |
| Policy | B05M000050 |
| Date of birth | 25 Dec 1995 |
| Plan | SILVER HMO |
| Covered from | 20 Apr 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 10.35 |
| Total | 10.35 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0000240 | 23 Dec 2025 | 69.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0000241 | 6 Sep 2025 | 196.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 196.00 |