RHP100420
Granite Plains Mutual. Visit on Aug 17, 2026 with Dr. Samuel Ivers.
What happened
- Allowed at the contract rate and paid in full: $118.00.
Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999020587030.
Next step
Paid correctly.
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 |
|---|---|---|---|---|---|---|
| 99213 Established patient visit, low complexity | $221.00 | $108.56 | $108.56 | $108.56 | $0.00 |
|
| 85025 Complete blood count | $19.00 | $9.44 | $9.44 | $9.44 | $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 |
|---|---|---|---|---|
| Aug 31, 2026 | GP99900000587 | Paid as expected | Current | $118.00 |
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As billed
- Date of service
- Aug 17, 2026
- Sent to payer
- Aug 19, 2026
- Provider
- Dr. Samuel Ivers
- Location
- Main CampusMain Campus, East Region
- Patient
- SYN-0420 (synthetic reference)