Demonstration environment. Fictional organization, fictional payers, synthetic data throughout. No patient data. Changes you make stay in this browser only.
ParvinCorpPayer Remittance Bridge

Ridgeline Health Partners. Multi-specialty physician group, 6 sites, 14 providers. This demo covers 12 billing providers, 4 billing locations and 4 contracted payers.

Signed in as

Dana Whitfield, Billing Operations Lead. Imports remittance files, works denials and underpayments, and is the only role that can open a raw remittance file from a payer (835).

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OverviewThe numbers that matterWork queue (102)What to fix, by deadlineDenialsWhy money did not arriveAwaiting paymentBilled, no answer yetImport a fileCheck and load a payer's payment fileClaimsEvery claim and its resultRemittancesPayments receivedPayersContracts and performanceReason codesPlain language lookupOrganizationEntities, regions and sitesGuided tourFive minute walkthrough
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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.

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Payments dated Aug 4, 2026 to Sep 29, 2026, as of Oct 7, 2026. Whole organization, every site.

Filtered to: site Main Campus, Jefferson Park, Eastgate Family Care, Stonebridge or Riverside Orthopedics.

Every regionEast RegionWest Region
Every siteMain CampusJefferson ParkEastgate Family CareStonebridgeRiverbendRiverside Orthopedics
Denial rate
10.0%
57 of 572 claims, fully or partly
Refused
$19,180.32
Valued at the contract rate
Preventable before the visit
49.1%
$13,957.90: eligibility, authorization, payer order, enrollment
Codes in play
12
Distinct primary reasons

By kind of problem

  • Prior authorization Front end11 · $6,325.00
  • Eligibility Front end5 · $5,656.60
  • Medical necessity 9 · $2,942.60
  • Another payer is responsible Front end10 · $1,659.30
  • Coding error 7 · $819.50
  • Duplicate 3 · $546.96
  • Missing or invalid information 4 · $428.18
  • Provider not eligible Front end2 · $317.00
  • Not covered by the plan 2 · $186.44
  • Filed too late 1 · $153.40
  • Bundled into another service 1 · $84.50
  • Frequency or quantity limit 1 · $45.24

By payer

PayerDeniedRateRefused
Fernhollow Community Care12 of 10811.1%$1,534.26
Granite Plains Mutual19 of 1969.7%$3,648.56
Silver Mesa Senior Advantage12 of 1309.2%$5,294.00
Tallow Creek Health Plan14 of 13810.1%$8,703.50

By provider

Which clinician's claims are refused, largest refusal first. A pattern here usually points at documentation, coding habits, or an enrollment gap.

ProviderDeniedRateRefused
Dr. Tomas Varga3 of 456.7%$2,864.60
Dr. Victor Adeyemi3 of 446.8%$2,406.80
Dr. Samuel Ivers4 of 517.8%$343.14
Dr. Priya Raman4 of 468.7%$747.04
Dr. Grace Lindqvist4 of 468.7%$539.70
Dr. Owen Whitaker4 of 458.9%$2,061.80
Maya Chen, NP4 of 449.1%$646.84
Jordan Blake, PA-C5 of 4810.4%$2,191.60
Dr. Martin Osei6 of 5111.8%$3,058.10
Dr. Nina Castellano6 of 5012.0%$2,835.40
Dr. Alana Reyes7 of 5213.5%$676.24
Dr. Helen Park7 of 5014.0%$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.

LocationDeniedRateRefused
Riverside Orthopedics25 of 23910.5%$14,096.14
Stonebridge9 of 7112.7%$1,748.60
Eastgate Family Care9 of 1098.3%$1,732.90
Main Campus14 of 1539.2%$1,602.68

Every reason, with the usual fix

Payer reason codeWhat it meansUsual fixClaimsAt 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.9$2,942.60
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
4
Modifier does not fit the code
The procedure code does not agree with the modifier billed, or a required modifier is missing.Fix the modifier and send a corrected claim.7$819.50
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
16
Missing or invalid information
The claim is missing information or has a billing error. A remark code usually says which field.Read the remark code, fix the field it names, and resubmit.4$428.18
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
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.2$186.44
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
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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