RHP101007
Fernhollow Community Care. Visit on Jul 16, 2026 with Jordan Blake, PA-C.
What happened
- Allowed at the contract rate and paid in full: $109.98.
Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999044301010.
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 |
|---|---|---|---|---|---|---|
| 99214 Established patient visit, moderate complexity | $312.00 | $101.40 | $101.40 | $101.40 | $0.00 |
|
| 80053 Metabolic panel | $26.00 | $8.58 | $8.58 | $8.58 | $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 4, 2026 | 99900004301 | Paid as expected | Current | $109.98 |
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As billed
- Date of service
- Jul 16, 2026
- Sent to payer
- Jul 18, 2026
- Provider
- Jordan Blake, PA-C
- Location
- Eastgate Family CareEastgate Family Care, East Region
- Patient
- SYN-1007 (synthetic reference)