Demonstration environment. Fictional organization, fictional payers, synthetic data throughout. No patient data. Changes you make stay in this browser only.
ParvinCorpPayer Remittance Bridge

Ridgeline Health Partners. Multi-specialty physician group, 6 sites, 14 providers. This demo covers 12 billing providers, 4 billing locations and 4 contracted payers.

Signed in as

Dana Whitfield, Billing Operations Lead. Imports remittance files, works denials and underpayments, and is the only role that can open a raw remittance file from a payer (835).

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Claims / RHP100103

RHP100103

Tallow Creek Health Plan. Visit on Aug 1, 2026 with Dr. Samuel Ivers.

Paid as expectedReversed and reprocessed
Charged
$449.00
Contract expects
$243.10
Allowed per fee schedule
Payer allowed
$243.10
Payer paid
$243.10
Patient owes
$0.00
Deductible, coinsurance, copay
At stake
$0.00

What happened

  • Allowed at the contract rate and paid in full: $243.10.

Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999010498002C.

Next step

No action needed

Paid correctly.

Follow-up Resolved

Assigned to Dana Whitfield

Appeal. Disputed the old fee schedule. Payer reversed and reprocessed at the contract rate on the next remittance. Dana Whitfield, Sep 22, 2026Payer reference # TCH-APL-48213appeal-letter-RHP100103.pdf (PDF)
Earlier follow-ups
  1. Appeal, in progress. Sent the contract page with the correct rate. Payer rep said to allow two weeks. Assigned to Dana Whitfield. Dana Whitfield, Sep 15, 2026Payer reference # TCH-APL-48213appeal-letter-RHP100103.pdf (PDF)
  2. Appeal, open. Paid below the contract rate. Pulling the fee schedule that was in force on the date of service. Assigned to Lee Marsh. Dana Whitfield, Sep 9, 2026
Proof (optional)

Line by line

What was billed, what the contract says, and what the payer did with each service.

ServiceChargedContractAllowedPaidPatientAdjustments
99204 New patient visit, moderate complexity$408.00$221.00$221.00$221.00$0.00
  • CO-45 Above the contracted rate $187.00
93000 Electrocardiogram$41.00$22.10$22.10$22.10$0.00
  • CO-45 Above the contracted rate $18.90

Scroll sideways to see every column.

The codes on this claim, explained

CO-45Above the contracted rateContract rate

The charge is higher than the fee schedule or contracted amount. The difference is written off.

Contractual obligation: The practice absorbs this amount under its contract or the payer rules. It may not be billed to the patient.

Usual fix: Expected. Only a problem if the allowed amount is below your contract rate.

Payment history

Every remittance that answered this claim, oldest first.

PaidPaymentResultStatusPaid
Aug 23, 2026EFT9990000411UnderpaidSuperseded$223.65
Sep 21, 2026EFT9990000498ReversalSuperseded-$223.65
Sep 21, 2026EFT9990000498Paid as expectedCurrent$243.10

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As billed

Date of service
Aug 1, 2026
Sent to payer
Aug 3, 2026
Provider
Dr. Samuel Ivers
Location
Main CampusMain Campus, East Region
Patient
SYN-0103 (synthetic reference)