Claims / RHP100127

RHP100127

Silver Mesa Senior Advantage. Visit on Aug 21, 2026 with Dr. Martin Osei.

Underpaid

Charged

$624.00

Contract expects

$260.00

Allowed per fee schedule

Payer allowed

$247.00

Payer paid

$193.65

Patient owes

$49.40

Deductible, coinsurance, copay

At stake

$13.00

What happened

The payer allowed $247.00 against a contract rate of $260.00: $13.00 short.

Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999031177007.

Next step

AppealMore than 30 days

Dispute the shortfall against the contracted rate. Attach the fee schedule page.

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
73721 MRI of a leg joint	$624.00	$260.00	$247.00	$193.65	$49.40	CO-45 Above the contracted rate $377.00 CO-253 Sequestration $3.95 PR-2 Coinsurance $49.40

Scroll sideways to see every column.

The codes on this claim, explained

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.

Payment history

Every remittance that answered this claim, oldest first.

Paid	Payment	Result	Status	Paid
Sep 7, 2026	SM9990031177	Underpaid	Current	$193.65

Scroll sideways to see every column.

As billed

Payer: Silver Mesa Senior Advantage
Date of service: Aug 21, 2026
Sent to payer: Aug 23, 2026
Provider: Dr. Martin Osei
Location: Main CampusMain Campus, East Region
Patient: SYN-0127 (synthetic reference)