RHP100111
Granite Plains Mutual. Visit on Aug 7, 2026 with Dr. Alana Reyes.
What happened
- Allowed at the contract rate. The payer paid $136.99 and $15.23 is the patient share.
Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999020587001.
Next step
Paid correctly. The patient share goes on the next statement.
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 |
|---|---|---|---|---|---|---|
| 99213 Established patient visit, low complexity | $221.00 | $108.56 | $108.56 | $97.70 | $10.86 |
|
| 90471 Vaccine administration | $41.00 | $20.06 | $20.06 | $18.05 | $2.01 |
|
| 90686 Flu vaccine | $48.00 | $23.60 | $23.60 | $21.24 | $2.36 |
|
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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.
The patient percentage share of the allowed amount.
Patient responsibility: The patient owes this amount (deductible, coinsurance, copay or a non-covered service the patient agreed to).
Usual fix: Bill the patient for the coinsurance amount shown.
Payment history
Every remittance that answered this claim, oldest first.
| Paid | Payment | Result | Status | Paid |
|---|---|---|---|---|
| Aug 31, 2026 | GP99900000587 | Paid as expected | Current | $136.99 |
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As billed
- Date of service
- Aug 7, 2026
- Sent to payer
- Aug 9, 2026
- Provider
- Dr. Alana Reyes
- Location
- Eastgate Family CareEastgate Family Care, East Region
- Patient
- SYN-0111 (synthetic reference)