Claims / RHP100123

RHP100123

Silver Mesa Senior Advantage. Visit on Aug 17, 2026 with Dr. Samuel Ivers.

Partially denied

Charged

$353.00

Contract expects

$147.00

Allowed per fee schedule

Payer allowed

$130.00

Payer paid

$101.92

Patient owes

$26.00

Deductible, coinsurance, copay

At stake

$17.00

What happened

$41.00 refused, payer reason code CO-50 (the practice carries it; the patient may not be billed for it): The payer decided the service was not medically necessary.

Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999031177003.

Next step

AppealMore than 30 days

Appeal with the visit note and any supporting records.

Due Nov 6, 2026 (in 31 days; 60 days from the remittance date to appeal)

Print appeal summary

Follow-up

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	$312.00	$130.00	$130.00	$101.92	$26.00	CO-45 Above the contracted rate $182.00 CO-253 Sequestration $2.08 PR-2 Coinsurance $26.00
93000 Electrocardiogram Refused	$41.00	$17.00	$0.00	$0.00	$0.00	CO-50 Not medically necessary $41.00

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The codes on this claim, explained

CO-50Not medically necessaryMedical necessity

The payer decided the service was not medically necessary.

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

Usual fix: Appeal with the visit note and any supporting records.

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.

CO-253SequestrationContract rate

The federal sequestration reduction (currently 2 percent) on Medicare and Medicare Advantage payments.

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 on Medicare business. Not an underpayment.

PR-2CoinsurancePatient share

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.

Remark codes: N130 Check the plan benefit documents for restrictions on this service.

Payment history

Every remittance that answered this claim, oldest first.

Paid	Payment	Result	Status	Paid
Sep 7, 2026	SM9990031177	Partially denied	Current	$101.92

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As billed

Payer: Silver Mesa Senior Advantage
Date of service: Aug 17, 2026
Sent to payer: Aug 19, 2026
Provider: Dr. Samuel Ivers
Location: Main CampusMain Campus, East Region
Patient: SYN-0123 (synthetic reference)