SOFIA TANAKA
Dependent on policy B05M000882
Claims
2
Attributed to this person
Charged
657.00
Total submitted
Denied
501.00
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 | SOFIA TANAKA |
| Role on the policy | Dependent · relationship 19 |
| Policy | B05M000882 |
| Date of birth | 22 Sep 2023 |
| Plan | BRONZE EPO |
| Covered from | 29 Jul 2024 |
| Covered to | 23 Nov 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 |
|---|---|---|---|---|---|
| CLM0003748 | 13 Oct 2024 | 501.00 | NORTHSTAR MUTUAL | CARC 27 · ELIGIBILITY | 501.00 |
| CLM0003747 | 3 Oct 2024 | 156.00 | NORTHSTAR MUTUAL | Not denied | — |