RHP100510
Silver Mesa Senior Advantage. Visit on Aug 16, 2026 with Maya Chen, NP.
What happened
- $221.00 refused, payer reason code CO-22 (the practice carries it; the patient may not be billed for it): Coordination of benefits: the payer believes another plan should pay first.
- $48.00 refused, payer reason code CO-22 (the practice carries it; the patient may not be billed for it): Coordination of benefits: the payer believes another plan should pay first.
- $41.00 refused, payer reason code CO-22 (the practice carries it; the patient may not be billed for it): Coordination of benefits: the payer believes another plan should pay first.
Claim number matched exactly. Payer status: Denied. Payer claim number 999031177019.
Next step
Update coverage order with the patient and bill the primary plan.
Due Aug 16, 2027 (in 314 days; 365 days from the date of service to file)
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 Refused | $221.00 | $92.00 | $0.00 | $0.00 | $0.00 |
|
| 90471 Vaccine administration Refused | $41.00 | $17.00 | $0.00 | $0.00 | $0.00 |
|
| 90686 Flu vaccine Refused | $48.00 | $20.00 | $0.00 | $0.00 | $0.00 |
|
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The codes on this claim, explained
Coordination of benefits: the payer believes another plan should pay first.
Contractual obligation: The practice absorbs this amount under its contract or the payer rules. It may not be billed to the patient.
Usual fix: Update coverage order with the patient and bill the primary plan.
Payment history
Every remittance that answered this claim, oldest first.
| Paid | Payment | Result | Status | Paid |
|---|---|---|---|---|
| Sep 7, 2026 | SM9990031177 | Denied | Current | $0.00 |
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As billed
- Date of service
- Aug 16, 2026
- Sent to payer
- Aug 18, 2026
- Provider
- Maya Chen, NP
- Location
- Riverside OrthopedicsRiverside Orthopedics, West Region
- Patient
- SYN-0510 (synthetic reference)