NADIA YAMADA
Dependent on policy B05M000445
Claims
1
Attributed to this person
Charged
305.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
198.25
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 | NADIA YAMADA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000445 |
| Date of birth | 4 Jun 1983 |
| Plan | GOLD PPO |
| Covered from | 29 Mar 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 198.25 |
| Total | 198.25 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001873 | 11 Jun 2024 | 305.00 | NORTHSTAR MUTUAL | CARC 50 · MEDICAL_NECESSITY | 0.00 |