Claims / RHP100315

RHP100315

Tallow Creek Health Plan. Visit on Jul 27, 2026 with Dr. Owen Whitaker.

Denied

Charged

$2,520.00

Contract expects

$1,365.00

Allowed per fee schedule

Payer allowed

$0.00

Payer paid

$0.00

Patient owes

$0.00

Deductible, coinsurance, copay

At stake

$1,365.00

What happened

$2520.00 refused, payer reason code CO-197 (the practice carries it; the patient may not be billed for it): Authorization or notification was required and not on file.

Claim number matched exactly. Payer status: Denied. Payer claim number 999010411026.

AppealMore than 30 days

If authorization was obtained, appeal with the number. If not, write off; it cannot be billed to the patient.

Due Nov 21, 2026 (in 46 days; 90 days from the remittance date to appeal)

Follow-up

Assigned to Nobody yet

Nobody has recorded a follow-up yet.

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

Service	Charged	Contract	Allowed	Paid	Patient	Adjustments
29827 Shoulder arthroscopy, rotator cuff repair Refused	$2,520.00	$1,365.00	$0.00	$0.00	$0.00	CO-197 Prior authorization missing $2,520.00

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CO-197Prior authorization missingPrior authorization

Authorization or notification was required and not on file.

Contractual obligation: The practice absorbs this amount under its contract or the payer rules. It may not be billed to the patient.

Usual fix: If authorization was obtained, appeal with the number. If not, write off; it cannot be billed to the patient.

Every remittance that answered this claim, oldest first.

Paid	Payment	Result	Status	Paid
Aug 23, 2026	EFT9990000411	Denied	Current	$0.00

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