Claims / RHP101243

RHP101243

Granite Plains Mutual. Visit on Jul 29, 2026 with Dr. Victor Adeyemi.

Underpaid

Charged

$2,520.00

Contract expects

$1,239.00

Allowed per fee schedule

Payer allowed

$1,127.49

Payer paid

$1,127.49

Patient owes

$0.00

Deductible, coinsurance, copay

At stake

$111.51

What happened

Claim number matched exactly. Payer status: Processed as primary. Payer claim number 999020544046.

AppealMore than 30 days

Dispute the shortfall against the contracted rate. Attach the fee schedule page.

Due Feb 13, 2027 (in 130 days; 180 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
29827 Shoulder arthroscopy, rotator cuff repair	$2,520.00	$1,239.00	$1,127.49	$1,127.49	$0.00	CO-45 Above the contracted rate $1,392.51

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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.

Every remittance that answered this claim, oldest first.

Paid	Payment	Result	Status	Paid
Aug 17, 2026	GP99900000544	Underpaid	Current	$1,127.49

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