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 Main Campus or Jefferson Park.
Denial rate
9.2%
14 of 153 claims, fully or partly
Refused
$1,602.68
Valued at the contract rate
Preventable before the visit
0.0%
$0.00: eligibility, authorization, payer order, enrollment
Codes in play
4
Distinct primary reasons
By kind of problem
- Coding error 7 · $819.50
- Missing or invalid information 4 · $428.18
- Medical necessity 2 · $237.00
- Not covered by the plan 1 · $118.00
By payer
| Payer | Denied | Rate | Refused |
|---|---|---|---|
| Fernhollow Community Care | 2 of 27 | 7.4% | $119.34 |
| Granite Plains Mutual | 5 of 53 | 9.4% | $528.64 |
| Silver Mesa Senior Advantage | 4 of 35 | 11.4% | $449.00 |
| Tallow Creek Health Plan | 3 of 38 | 7.9% | $505.70 |
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 |
|---|---|---|---|
| Maya Chen, NP | 0 of 1 | 0.0% | $0.00 |
| Dr. Samuel Ivers | 4 of 51 | 7.8% | $343.14 |
| Dr. Nina Castellano | 2 of 5 | 40.0% | $236.00 |
| Dr. Martin Osei | 1 of 5 | 20.0% | $214.50 |
| Dr. Grace Lindqvist | 4 of 46 | 8.7% | $539.70 |
| Dr. Alana Reyes | 3 of 45 | 6.7% | $269.34 |
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 |
|---|---|---|---|
| Main Campus | 14 of 153 | 9.2% | $1,602.68 |
Every reason, with the usual fix
| Payer reason code | What it means | Usual fix | Claims | At stake |
|---|---|---|---|---|
| 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 |
| 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 |
| 50 Not medically necessary | The payer decided the service was not medically necessary. | Appeal with the visit note and any supporting records. | 2 | $237.00 |
| 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. | 1 | $118.00 |
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