Claims / RHP101200

RHP101200

Granite Plains Mutual. Visit on Aug 6, 2026 with Dr. Samuel Ivers.

Paid as expected

Charged

$228.00

Contract expects

$112.10

Allowed per fee schedule

Payer allowed

$112.10

Payer paid

$87.10

Patient owes

$25.00

Deductible, coinsurance, copay

At stake

$0.00

What happened

Allowed at the contract rate. The payer paid $87.10 and $25.00 is the patient share.

Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999020544003.

No action needed

Paid correctly. The patient share goes on the next statement.

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
99213 Established patient visit, low complexity	$221.00	$108.56	$108.56	$83.56	$25.00	CO-45 Above the contracted rate $112.44 PR-3 Copay $25.00
36415 Blood draw	$7.00	$3.54	$3.54	$3.54	$0.00	CO-45 Above the contracted rate $3.46

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CO-45Above the contracted rateContract rate

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.

PR-3CopayPatient share

The fixed copay the patient owes for the visit.

Patient responsibility: The patient owes this amount (deductible, coinsurance, copay or a non-covered service the patient agreed to).

Usual fix: Collect the copay if it was not collected at check in.

Every remittance that answered this claim, oldest first.

Paid	Payment	Result	Status	Paid
Aug 18, 2026	GP99900000544	Paid as expected	Current	$87.10

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