Claims / RHP100241

RHP100241

Tallow Creek Health Plan. Visit on Aug 9, 2026 with Dr. Victor Adeyemi.

Paid as expected

Charged

$967.00

Contract expects

$523.90

Allowed per fee schedule

Payer allowed

$523.90

Payer paid

$419.12

Patient owes

$104.78

Deductible, coinsurance, copay

At stake

$0.00

What happened

Allowed at the contract rate. The payer paid $419.12 and $104.78 is the patient share.

Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999010498007C.

No action needed

Paid correctly. The patient share goes on the next statement.

Follow-up Resolved

Assigned to Dana Whitfield

Send a corrected claim. Corrected the rendering provider and resubmitted. Paid on the next payment. Dana Whitfield, Sep 21, 2026

What was billed, what the contract says, and what the payer did with each service.

Service	Charged	Contract	Allowed	Paid	Patient	Adjustments
99215 Established patient visit, high complexity	$439.00	$237.90	$237.90	$190.32	$47.58	CO-45 Above the contracted rate $201.10 PR-2 Coinsurance $47.58
93306 Echocardiogram, complete	$528.00	$286.00	$286.00	$228.80	$57.20	CO-45 Above the contracted rate $242.00 PR-2 Coinsurance $57.20

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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.

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.

Every remittance that answered this claim, oldest first.

Paid	Payment	Result	Status	Paid
Aug 23, 2026	EFT9990000411	Denied	Superseded	$0.00
Sep 21, 2026	EFT9990000498	Paid as expected	Current	$419.12

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