IVAN TANAKA
Dependent on policy B05M000882
Claims
3
Attributed to this person
Charged
1,373.00
Total submitted
Denied
660.00
2 denied claims
Patient responsibility
30.00
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 | IVAN TANAKA |
| Role on the policy | Dependent · relationship 01 |
| Policy | B05M000882 |
| Date of birth | 27 Apr 1993 |
| Plan | BRONZE EPO |
| Covered from | 29 Jul 2024 |
| Covered to | 23 Nov 2024 |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 3 · Copay | 1 | 30.00 |
| Total | 30.00 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003744 | 1 Jan 2025 | 713.00 | NORTHSTAR MUTUAL | Not denied | — |
| CLM0003743 | 26 Nov 2024 | 348.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 348.00 |
| CLM0003742 | 11 Jul 2024 | 312.00 | NORTHSTAR MUTUAL | CARC 26 · ELIGIBILITY | 312.00 |