LEILA TANAKA
Dependent on policy B05M000563
Claims
3
Attributed to this person
Charged
1,389.00
Total submitted
Denied
721.00
2 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 | LEILA TANAKA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000563 |
| Date of birth | 22 Feb 2006 |
| Plan | GOLD PPO |
| Covered from | 15 Jan 2024 |
| Covered to | 17 May 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002408 | 9 Jul 2024 | 659.00 | MERIDIAN HEALTH PLAN | CARC 27 · ELIGIBILITY | 659.00 |
| CLM0002410 | 6 May 2024 | 668.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002409 | 24 Mar 2024 | 62.00 | MERIDIAN HEALTH PLAN | CARC 29 · TIMELY_FILING | 62.00 |