Claims / RHP100106

RHP100106

Tallow Creek Health Plan. Visit on Aug 4, 2026 with Dr. Alana Reyes.

Partially denied

Charged

$468.00

Contract expects

$253.50

Allowed per fee schedule

Payer allowed

$169.00

Payer paid

$169.00

Patient owes

$0.00

Deductible, coinsurance, copay

At stake

$84.50

What happened

$156.00 refused, payer reason code CO-97 (the practice carries it; the patient may not be billed for it): Payment for this service is included in another service on the same day.

Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999010411006.

Send a corrected claimDue within 30 days

If the service was separate and distinct, add the right modifier and send a corrected claim.

Due Nov 2, 2026 (in 27 days; 90 days from the date of service to file)

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
99214 Established patient visit, moderate complexity	$312.00	$169.00	$169.00	$169.00	$0.00	CO-45 Above the contracted rate $143.00
20610 Large joint injection Refused	$156.00	$84.50	$0.00	$0.00	$0.00	CO-97 Bundled into another service $156.00

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CO-97Bundled into another serviceBundled into another service

Payment for this service is included in another service on the same day.

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 the service was separate and distinct, add the right modifier and send a corrected claim.

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.

Remark codes: M15 Separately billed services were bundled as parts of the same procedure.

Every remittance that answered this claim, oldest first.

Paid	Payment	Result	Status	Paid
Aug 23, 2026	EFT9990000411	Partially denied	Current	$169.00

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