Claims / RHP100104

RHP100104

Tallow Creek Health Plan. Visit on Aug 2, 2026 with Dr. Helen Park.

Partially denied

Charged

$377.00

Contract expects

$204.10

Allowed per fee schedule

Payer allowed

$119.60

Payer paid

$119.60

Patient owes

$0.00

Deductible, coinsurance, copay

At stake

$84.50

What happened

$156.00 refused, payer reason code CO-197 (the practice carries it; the patient may not be billed for it): Authorization or notification was required and not on file.

Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999010411004.

AppealMore than 30 days

If authorization was obtained, appeal with the number. If not, write off; it cannot be billed to the patient.

Due Nov 21, 2026 (in 46 days; 90 days from the remittance date to appeal)

Follow-up

Assigned to Nobody yet

Nobody has recorded a follow-up yet.

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

Service	Charged	Contract	Allowed	Paid	Patient	Adjustments
99213 Established patient visit, low complexity	$221.00	$119.60	$119.60	$119.60	$0.00	CO-45 Above the contracted rate $101.40
20610 Large joint injection Refused	$156.00	$84.50	$0.00	$0.00	$0.00	CO-197 Prior authorization missing $156.00

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CO-197Prior authorization missingPrior authorization

Authorization or notification was required and not on file.

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

Usual fix: If authorization was obtained, appeal with the number. If not, write off; it cannot be billed to the patient.

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.

Every remittance that answered this claim, oldest first.

Paid	Payment	Result	Status	Paid
Aug 23, 2026	EFT9990000411	Partially denied	Current	$119.60

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