VICTOR TANAKA
Dependent on policy B05M000816
Claims
1
Attributed to this person
Charged
873.00
Total submitted
Denied
873.00
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 | VICTOR TANAKA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000816 |
| Date of birth | 12 Apr 2000 |
| 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 |
|---|---|---|---|---|---|
| CLM0003471 | 13 Jul 2024 | 873.00 | NORTHSTAR MUTUAL | CARC 29 · TIMELY_FILING | 873.00 |