Appeal summary
Claim RHP100125. Appeal.
Ridgeline Health Partners
Billing NPI 9999999001 (fictional)
Prepared Oct 7, 2026
Appeal due by Nov 7, 2026 (60 days from remittance, per contract).
- Payer
- Silver Mesa Senior Advantage
- Payer ID
- 99903
- Payer claim number
- 999031177005
- Practice claim number
- RHP100125
- Date of service
- Aug 20, 2026
- Rendering provider
- Jordan Blake, PA-C
- Location
- Stonebridge
- Payment trace
- SM9990031177, Sep 8, 2026
Line by line, against the contract
| Billed | Paid as | Charged | Contract rate | Allowed | Paid | Shortfall |
|---|---|---|---|---|---|---|
| 99204 | Refused | $408.00 | $170.00 | $0.00 | $0.00 | $170.00 |
| Total | $408.00 | $170.00 | $0.00 | $0.00 | $170.00 | |
Reason and remark codes on the remittance
- CO-185 (adjustment reason), $408.00: Contractual obligation. The rendering provider is not eligible to perform the service billed.
- N290 (remark): The rendering provider identifier was missing or invalid.
Basis for the request
Check the provider enrollment with this payer. A credentialing gap is the usual cause.
The practice asks the payer to reprocess this claim at the contracted rate: $170.00 below contract on the lines above.