RHP100105
Tallow Creek Health Plan. Visit on Aug 3, 2026 with Dr. Martin Osei.
What happened
- The payer allowed $169.00 against a contract rate of $237.90: $68.90 short.
- The payer changed 99215 to 99214 and paid the lower code's rate.
Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999010411005.
Next step
Dispute the shortfall against the contracted rate. Attach the fee schedule page.
Due Nov 21, 2026 (in 46 days; 90 days from the remittance date to appeal)
Assigned to Nobody yet
Nobody has recorded a follow-up yet.
Line by line
What was billed, what the contract says, and what the payer did with each service.
| Service | Charged | Contract | Allowed | Paid | Patient | Adjustments |
|---|---|---|---|---|---|---|
| 99214 Established patient visit, moderate complexity Billed as 99215 | $439.00 | $237.90 | $169.00 | $169.00 | $0.00 |
|
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The codes on this claim, explained
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.
| Paid | Payment | Result | Status | Paid |
|---|---|---|---|---|
| Aug 23, 2026 | EFT9990000411 | Underpaid | Current | $169.00 |
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As billed
- Date of service
- Aug 3, 2026
- Sent to payer
- Aug 5, 2026
- Provider
- Dr. Martin Osei
- Location
- StonebridgeStonebridge, West Region
- Patient
- SYN-0105 (synthetic reference)