Claims / RHP100536

RHP100536

Silver Mesa Senior Advantage. Visit on Aug 26, 2026 with Dr. Alana Reyes.

Denied

Charged

$269.00

Contract expects

$112.00

Allowed per fee schedule

Payer allowed

$0.00

Payer paid

$0.00

Patient owes

$0.00

Deductible, coinsurance, copay

At stake

$112.00

What happened

$269.00 refused, payer reason code CO-4 (the practice carries it; the patient may not be billed for it): The procedure code does not agree with the modifier billed, or a required modifier is missing.

Claim number matched exactly. Payer status: Denied. Payer claim number 999031177045.

Send a corrected claimMore than 30 days

Fix the modifier and send a corrected claim.

Due Aug 26, 2027 (in 324 days; 365 days from the date of service to file)

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
99203 New patient visit, low complexity Refused	$269.00	$112.00	$0.00	$0.00	$0.00	CO-4 Modifier does not fit the code $269.00

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CO-4Modifier does not fit the codeCoding error

The procedure code does not agree with the modifier billed, or a required modifier is missing.

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

Usual fix: Fix the modifier and send a corrected claim.

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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