RHP100708
Tallow Creek Health Plan. Visit on Sep 2, 2026 with Dr. Samuel Ivers.
What happened
- Allowed at the contract rate and paid in full: $130.00.
Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999010498016.
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 | $119.60 | $119.60 | $119.60 | $0.00 |
|
| 85025 Complete blood count | $19.00 | $10.40 | $10.40 | $10.40 | $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 |
|---|---|---|---|---|
| Sep 22, 2026 | EFT9990000498 | Paid as expected | Current | $130.00 |
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As billed
- Date of service
- Sep 2, 2026
- Sent to payer
- Sep 4, 2026
- Provider
- Dr. Samuel Ivers
- Location
- Main CampusMain Campus, East Region
- Patient
- SYN-0708 (synthetic reference)