OMAR TANAKA
Dependent on policy B05M000472
Claims
3
Attributed to this person
Charged
1,714.00
Total submitted
Denied
188.04
2 denied claims
Patient responsibility
424.45
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 | OMAR TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000472 |
| Date of birth | 6 Apr 2016 |
| Plan | PLATINUM PPO |
| Covered from | 9 Feb 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 424.45 |
| Total | 424.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0001989 | 22 Jun 2026 | 662.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0001990 | 1 Dec 2025 | 399.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 188.04 |
| CLM0001988 | 15 Nov 2025 | 653.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |