PRIYA TANAKA
Subscriber on policy B05M000413
Claims
1
Attributed to this person
Charged
199.00
Total submitted
Denied
199.00
1 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 | PRIYA TANAKA |
| Role on the policy | Subscriber |
| Policy | B05M000413 |
| Date of birth | 27 Feb 1975 |
| Plan | GOLD PPO |
| Covered from | 20 Feb 2025 |
| Covered to | 18 Jul 2025 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001748 | 28 May 2025 | 199.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 199.00 |