MARCUS TANAKA
Dependent on policy B05M000650
Claims
2
Attributed to this person
Charged
1,140.00
Total submitted
Denied
582.00
1 denied claims
Patient responsibility
111.60
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 | MARCUS TANAKA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000650 |
| Date of birth | 5 Oct 1953 |
| Plan | SILVER HMO |
| Covered from | 15 Jun 2025 |
| Covered to | 7 Oct 2025 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 2 · Coinsurance | 1 | 111.60 |
| Total | 111.60 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002798 | 18 Oct 2025 | 582.00 | MERIDIAN HEALTH PLAN | CARC 18 · DUPLICATE | 582.00 |
| CLM0002797 | 18 Jun 2025 | 558.00 | MERIDIAN HEALTH PLAN | Not denied | — |