RHP100154
Granite Plains Mutual. Visit on Sep 9, 2026 with Dr. Samuel Ivers.
What happened
- The payer allowed $207.42 against a contract rate of $220.66: $13.24 short.
Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999020631004.
Next step
Dispute the shortfall against the contracted rate. Attach the fee schedule page.
Due Mar 27, 2027 (in 172 days; 180 days from the remittance date to appeal)
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 |
|---|---|---|---|---|---|---|
| 99204 New patient visit, moderate complexity | $408.00 | $200.60 | $188.56 | $188.56 | $0.00 |
|
| 93000 Electrocardiogram | $41.00 | $20.06 | $18.86 | $18.86 | $0.00 |
|
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The codes on this claim, explained
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.
Payment history
Every remittance that answered this claim, oldest first.
| Paid | Payment | Result | Status | Paid |
|---|---|---|---|---|
| Sep 28, 2026 | GP99900000631 | Underpaid | Current | $207.42 |
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As billed
- Date of service
- Sep 9, 2026
- Sent to payer
- Sep 11, 2026
- Provider
- Dr. Samuel Ivers
- Location
- Main CampusMain Campus, East Region
- Patient
- SYN-0154 (synthetic reference)