RHP100300
Tallow Creek Health Plan. Visit on Aug 11, 2026 with Dr. Samuel Ivers.
What happened
- Allowed at the contract rate. The payer paid $60.32 and $15.08 is the patient share.
Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999010411011.
Next step
Paid correctly. The patient share goes on the next statement.
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 |
|---|---|---|---|---|---|---|
| 97110 Therapeutic exercise, 15 minutes | $140.00 | $75.40 | $75.40 | $60.32 | $15.08 |
|
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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.
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 |
|---|---|---|---|---|
| Aug 23, 2026 | EFT9990000411 | Paid as expected | Current | $60.32 |
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As billed
- Date of service
- Aug 11, 2026
- Sent to payer
- Aug 13, 2026
- Provider
- Dr. Samuel Ivers
- Location
- Main CampusMain Campus, East Region
- Patient
- SYN-0300 (synthetic reference)