Appeal summary
Claim RHP100136. Appeal.
Ridgeline Health Partners
Billing NPI 9999999001 (fictional)
Prepared Oct 7, 2026
Appeal due by Nov 14, 2026 (60 days from remittance, per contract).
- Payer
- Fernhollow Community Care
- Payer ID
- 99904
- Payer claim number
- 999044410006
- Practice claim number
- RHP100136
- Date of service
- Aug 28, 2026
- Rendering provider
- Dr. Helen Park
- Location
- Riverside Orthopedics
- Payment trace
- 99900004410, Sep 15, 2026
Line by line, against the contract
| Billed | Paid as | Charged | Contract rate | Allowed | Paid | Shortfall |
|---|---|---|---|---|---|---|
| 97110 | Refused | $140.00 | $45.24 | $0.00 | $0.00 | $45.24 |
| Total | $140.00 | $45.24 | $0.00 | $0.00 | $45.24 | |
Reason and remark codes on the remittance
- CO-151 (adjustment reason), $140.00: Contractual obligation. The payer says the information does not support this many services or this frequency.
Basis for the request
Appeal with documentation supporting the number of services.
The practice asks the payer to reprocess this claim at the contracted rate: $45.24 below contract on the lines above.