Claims / RHP100705

RHP100705

Tallow Creek Health Plan. Visit on Sep 4, 2026 with Dr. Martin Osei.

Denied

Charged

$1,728.00

Contract expects

$936.00

Allowed per fee schedule

Payer allowed

$0.00

Payer paid

$0.00

Patient owes

$0.00

Deductible, coinsurance, copay

At stake

$936.00

What happened

$1728.00 refused, payer reason code CO-50 (the practice carries it; the patient may not be billed for it): The payer decided the service was not medically necessary.

Claim number matched exactly. Payer status: Denied. Payer claim number 999010498013.

AppealMore than 30 days

Appeal with the visit note and any supporting records.

Due Dec 20, 2026 (in 75 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
29881 Knee arthroscopy with meniscectomy Refused	$1,728.00	$936.00	$0.00	$0.00	$0.00	CO-50 Not medically necessary $1,728.00

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CO-50Not medically necessaryMedical necessity

The payer decided the service was not medically necessary.

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

Usual fix: Appeal with the visit note and any supporting records.

Remark codes: N130 Check the plan benefit documents for restrictions on this service.

Every remittance that answered this claim, oldest first.

Paid	Payment	Result	Status	Paid
Sep 21, 2026	EFT9990000498	Denied	Current	$0.00

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