IVAN TANAKA
Dependent on policy B05M000459
Claims
3
Attributed to this person
Charged
1,084.00
Total submitted
Denied
647.00
1 denied claims
Patient responsibility
31.65
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 | IVAN TANAKA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000459 |
| Date of birth | 23 Dec 1988 |
| Plan | GOLD PPO |
| Covered from | 12 May 2025 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 1 · Deductible | 1 | 31.65 |
| Total | 31.65 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001931 | 16 Oct 2025 | 211.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001932 | 30 Sep 2025 | 226.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001933 | 14 Apr 2025 | 647.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 647.00 |