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 or Stonebridge.
Denial rate
10.0%
18 of 180 claims, fully or partly
Refused
$3,481.50
Valued at the contract rate
Preventable before the visit
55.6%
$2,212.20: eligibility, authorization, payer order, enrollment
Codes in play
8
Distinct primary reasons
By kind of problem
- Prior authorization Front end5 · $1,326.00
- Medical necessity 4 · $862.40
- Eligibility Front end2 · $436.60
- Provider not eligible Front end2 · $317.00
- Filed too late 1 · $153.40
- Duplicate 1 · $153.40
- Another payer is responsible Front end1 · $132.60
- Bundled into another service 1 · $84.50
By payer
| Payer | Denied | Rate | Refused |
|---|---|---|---|
| Fernhollow Community Care | 6 of 37 | 16.2% | $897.00 |
| Granite Plains Mutual | 9 of 58 | 15.5% | $2,183.00 |
| Silver Mesa Senior Advantage | 2 of 41 | 4.9% | $317.00 |
| Tallow Creek Health Plan | 1 of 44 | 2.3% | $84.50 |
By provider
Which clinician's claims are refused, largest refusal first. A pattern here usually points at documentation, coding habits, or an enrollment gap.
| Provider | Denied | Rate | Refused |
|---|---|---|---|
| Dr. Alana Reyes | 4 of 7 | 57.1% | $406.90 |
| Dr. Nina Castellano | 3 of 23 | 13.0% | $714.40 |
| Dr. Martin Osei | 3 of 23 | 13.0% | $457.60 |
| Jordan Blake, PA-C | 4 of 38 | 10.5% | $826.60 |
| Dr. Owen Whitaker | 2 of 32 | 6.3% | $509.60 |
| Dr. Tomas Varga | 1 of 23 | 4.3% | $259.60 |
| Dr. Victor Adeyemi | 1 of 34 | 2.9% | $306.80 |
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 |
|---|---|---|---|
| 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. | 5 | $1,326.00 |
| 50 Not medically necessary | The payer decided the service was not medically necessary. | Appeal with the visit note and any supporting records. | 4 | $862.40 |
| 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). | 2 | $436.60 |
| 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 |
| 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. | 1 | $153.40 |
| 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. | 1 | $132.60 |
| 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 |
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