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 Riverbend or Riverside Orthopedics.
Denial rate
10.5%
25 of 239 claims, fully or partly
Refused
$14,096.14
Valued at the contract rate
Preventable before the visit
72.0%
$11,745.70: eligibility, authorization, payer order, enrollment
Codes in play
7
Distinct primary reasons
By kind of problem
- Eligibility Front end3 · $5,220.00
- Prior authorization Front end6 · $4,999.00
- Medical necessity 3 · $1,843.20
- Another payer is responsible Front end9 · $1,526.70
- Duplicate 2 · $393.56
- Not covered by the plan 1 · $68.44
- Frequency or quantity limit 1 · $45.24
By payer
| Payer | Denied | Rate | Refused |
|---|---|---|---|
| Fernhollow Community Care | 4 of 44 | 9.1% | $517.92 |
| Granite Plains Mutual | 5 of 85 | 5.9% | $936.92 |
| Silver Mesa Senior Advantage | 6 of 54 | 11.1% | $4,528.00 |
| Tallow Creek Health Plan | 10 of 56 | 17.9% | $8,113.30 |
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. Helen Park | 7 of 50 | 14.0% | $809.06 |
| Dr. Priya Raman | 4 of 46 | 8.7% | $747.04 |
| Maya Chen, NP | 4 of 43 | 9.3% | $646.84 |
| Dr. Martin Osei | 2 of 23 | 8.7% | $2,386.00 |
| Dr. Tomas Varga | 2 of 22 | 9.1% | $2,605.00 |
| Dr. Nina Castellano | 1 of 22 | 4.5% | $1,885.00 |
| Dr. Owen Whitaker | 2 of 13 | 15.4% | $1,552.20 |
| Dr. Victor Adeyemi | 2 of 10 | 20.0% | $2,100.00 |
| Jordan Blake, PA-C | 1 of 10 | 10.0% | $1,365.00 |
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 |
Every reason, with the usual fix
| Payer reason code | What it means | Usual fix | Claims | At stake |
|---|---|---|---|---|
| 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). | 3 | $5,220.00 |
| 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. | 6 | $4,999.00 |
| 50 Not medically necessary | The payer decided the service was not medically necessary. | Appeal with the visit note and any supporting records. | 3 | $1,843.20 |
| 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. | 9 | $1,526.70 |
| 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. | 2 | $393.56 |
| 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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