Claims / RHP100116

RHP100116

Granite Plains Mutual. Visit on Aug 12, 2026 with Dr. Nina Castellano.

Partially denied

Charged

$461.00

Contract expects

$226.56

Allowed per fee schedule

Payer allowed

$108.56

Payer paid

$108.56

Patient owes

$0.00

Deductible, coinsurance, copay

At stake

$118.00

What happened

$240.00 refused, payer reason code CO-4 (the practice carries it; the patient may not be billed for it): The procedure code does not agree with the modifier billed, or a required modifier is missing.

Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999020587006.

Send a corrected claimMore than 30 days

Fix the modifier and send a corrected claim.

Due Feb 8, 2027 (in 125 days; 180 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
99213 Established patient visit, low complexity	$221.00	$108.56	$108.56	$108.56	$0.00	CO-45 Above the contracted rate $112.44
11102 Skin biopsy Refused	$240.00	$118.00	$0.00	$0.00	$0.00	CO-4 Modifier does not fit the code $240.00

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CO-4Modifier does not fit the codeCoding error

The procedure code does not agree with the modifier billed, or a required modifier is missing.

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

Usual fix: Fix the 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.

Every remittance that answered this claim, oldest first.

Paid	Payment	Result	Status	Paid
Aug 31, 2026	GP99900000587	Partially denied	Current	$108.56

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