Denials
Why payers refused money, grouped the way a practice fixes it. Each reason is the largest refusal on the claim; the claim page lists every code.
Payments dated Aug 4, 2026 to Sep 29, 2026, as of Oct 7, 2026. Whole organization, every site.
Filtered to: site Jefferson Park, Eastgate Family Care, Stonebridge or Riverside Orthopedics.
Denial rate
10.3%
43 of 419 claims, fully or partly
Refused
$17,577.64
Valued at the contract rate
Preventable before the visit
65.1%
$13,957.90: eligibility, authorization, payer order, enrollment
Codes in play
10
Distinct primary reasons
By kind of problem
- Prior authorization Front end11 · $6,325.00
- Eligibility Front end5 · $5,656.60
- Medical necessity 7 · $2,705.60
- Another payer is responsible Front end10 · $1,659.30
- Duplicate 3 · $546.96
- Provider not eligible Front end2 · $317.00
- Filed too late 1 · $153.40
- Bundled into another service 1 · $84.50
- Not covered by the plan 1 · $68.44
- Frequency or quantity limit 1 · $45.24
By payer
| Payer | Denied | Rate | Refused |
|---|---|---|---|
| Fernhollow Community Care | 10 of 81 | 12.3% | $1,414.92 |
| Granite Plains Mutual | 14 of 143 | 9.8% | $3,119.92 |
| Silver Mesa Senior Advantage | 8 of 95 | 8.4% | $4,845.00 |
| Tallow Creek Health Plan | 11 of 100 | 11.0% | $8,197.80 |
By provider
Which clinician's claims are refused, largest refusal first. A pattern here usually points at documentation, coding habits, or an enrollment gap.
| Provider | Denied | Rate | Refused |
|---|---|---|---|
| Dr. Alana Reyes | 4 of 7 | 57.1% | $406.90 |
| Maya Chen, NP | 4 of 43 | 9.3% | $646.84 |
| Dr. Victor Adeyemi | 3 of 44 | 6.8% | $2,406.80 |
| Dr. Tomas Varga | 3 of 45 | 6.7% | $2,864.60 |
| Dr. Nina Castellano | 4 of 45 | 8.9% | $2,599.40 |
| Dr. Owen Whitaker | 4 of 45 | 8.9% | $2,061.80 |
| Dr. Martin Osei | 5 of 46 | 10.9% | $2,843.60 |
| Dr. Priya Raman | 4 of 46 | 8.7% | $747.04 |
| Jordan Blake, PA-C | 5 of 48 | 10.4% | $2,191.60 |
| Dr. Helen Park | 7 of 50 | 14.0% | $809.06 |
By location
Which site's claims are refused. A pattern here usually points at the front desk: eligibility checks, authorizations, or the wrong payer on file. Each location opens its site's claims.
| Location | Denied | Rate | Refused |
|---|---|---|---|
| Riverside Orthopedics | 25 of 239 | 10.5% | $14,096.14 |
| Stonebridge | 9 of 71 | 12.7% | $1,748.60 |
| Eastgate Family Care | 9 of 109 | 8.3% | $1,732.90 |
Every reason, with the usual fix
| Payer reason code | What it means | Usual fix | Claims | At stake |
|---|---|---|---|---|
| 197 Prior authorization missing | Authorization or notification was required and not on file. | If authorization was obtained, appeal with the number. If not, write off; it cannot be billed to the patient. | 11 | $6,325.00 |
| 27 After coverage ended | The service date is after the patient coverage ended. | Verify eligibility for the service date and bill the plan that covered it. The patient can be billed only when the payer sends it as patient responsibility (group PR). | 5 | $5,656.60 |
| 50 Not medically necessary | The payer decided the service was not medically necessary. | Appeal with the visit note and any supporting records. | 7 | $2,705.60 |
| 22 Another payer may be primary | Coordination of benefits: the payer believes another plan should pay first. | Update coverage order with the patient and bill the primary plan. | 10 | $1,659.30 |
| 18 Exact duplicate | The payer already received this exact claim or service. | Confirm the original claim was paid. If it was, no action is needed. | 3 | $546.96 |
| 185 Rendering provider not eligible | The rendering provider is not eligible to perform the service billed. | Check the provider enrollment with this payer. A credentialing gap is the usual cause. | 2 | $317.00 |
| 29 Filing deadline passed | The claim reached the payer after its timely filing limit. | Appeal only with proof of timely submission; otherwise write it off. It cannot be billed to the patient. | 1 | $153.40 |
| 97 Bundled into another service | Payment for this service is included in another service on the same day. | If the service was separate and distinct, add the right modifier and send a corrected claim. | 1 | $84.50 |
| 96 Non-covered charge | The service is not covered. A remark code usually says why. | Bill the patient only if they signed a waiver or the plan allows it; otherwise write off. | 1 | $68.44 |
| 151 More services than the payer allows | The payer says the information does not support this many services or this frequency. | Appeal with documentation supporting the number of services. | 1 | $45.24 |
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