WENDY TANAKA
Subscriber on policy B05M000825
Claims
3
Attributed to this person
Charged
1,106.00
Total submitted
Denied
121.29
2 denied claims
Patient responsibility
357.50
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 | WENDY TANAKA |
| Role on the policy | Subscriber |
| Policy | B05M000825 |
| Date of birth | 5 May 1984 |
| Plan | GOLD PPO |
| Covered from | 27 Dec 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 96 · Other | 1 | 357.50 |
| Total | 357.50 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003495 | 18 Mar 2026 | 279.00 | NORTHSTAR MUTUAL | CARC 16 · BILLING_ERROR | 121.29 |
| CLM0003494 | 14 Oct 2025 | 550.00 | NORTHSTAR MUTUAL | CARC 96 · NON_COVERED | 0.00 |
| CLM0003493 | 1 Aug 2025 | 277.00 | NORTHSTAR MUTUAL | Not denied | — |