PRIYA TANAKA
Subscriber on policy B05M000816
Claims
2
Attributed to this person
Charged
1,040.00
Total submitted
Denied
527.73
2 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 | B05M000816 |
| Date of birth | 12 Nov 2002 |
| Plan | PLATINUM PPO |
| Covered from | 18 May 2024 |
| Covered to | 23 Dec 2024 |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003470 | 2 Jan 2025 | 336.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 336.00 |
| CLM0003469 | 13 Sep 2024 | 704.00 | NORTHSTAR MUTUAL | CARC 11 · CODING | 191.73 |