Appeal summary
Claim RHP100112. Appeal.
Ridgeline Health Partners
Billing NPI 9999999001 (fictional)
Prepared Oct 7, 2026
Appeal due by Feb 28, 2027 (180 days from remittance, per contract).
- Payer
- Granite Plains Mutual
- Payer ID
- 99902
- Payer claim number
- 999020587002
- Practice claim number
- RHP100112
- Date of service
- Feb 19, 2026
- Rendering provider
- Dr. Martin Osei
- Location
- Stonebridge
- Payment trace
- GP99900000587, Sep 1, 2026
Line by line, against the contract
| Billed | Paid as | Charged | Contract rate | Allowed | Paid | Shortfall |
|---|---|---|---|---|---|---|
| 99214 | Refused | $312.00 | $153.40 | $0.00 | $0.00 | $153.40 |
| Total | $312.00 | $153.40 | $0.00 | $0.00 | $153.40 | |
Reason and remark codes on the remittance
- CO-29 (adjustment reason), $312.00: Contractual obligation. The claim reached the payer after its timely filing limit.
Basis for the request
Appeal only with proof of timely submission; otherwise write it off. It cannot be billed to the patient.
The practice asks the payer to reprocess this claim at the contracted rate: $153.40 below contract on the lines above.