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: region East Region or West Region; site Main Campus, Jefferson Park or Stonebridge.
Denial rate
10.3%
23 of 224 claims, fully or partly
Refused
$3,351.28
Valued at the contract rate
Preventable before the visit
17.4%
$732.80: eligibility, authorization, payer order, enrollment
Codes in play
8
Distinct primary reasons
By kind of problem
- Medical necessity 6 · $1,099.40
- Coding error 7 · $819.50
- Missing or invalid information 4 · $428.18
- Provider not eligible Front end2 · $317.00
- Eligibility Front end1 · $283.20
- Filed too late 1 · $153.40
- Another payer is responsible Front end1 · $132.60
- Not covered by the plan 1 · $118.00
By payer
| Payer | Denied | Rate | Refused |
|---|---|---|---|
| Fernhollow Community Care | 5 of 42 | 11.9% | $595.14 |
| Granite Plains Mutual | 9 of 75 | 12.0% | $1,484.44 |
| Silver Mesa Senior Advantage | 6 of 52 | 11.5% | $766.00 |
| Tallow Creek Health Plan | 3 of 55 | 5.5% | $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 |
|---|---|---|---|
| Dr. Nina Castellano | 5 of 28 | 17.9% | $950.40 |
| Dr. Martin Osei | 4 of 28 | 14.3% | $672.10 |
| Dr. Grace Lindqvist | 4 of 46 | 8.7% | $539.70 |
| Dr. Samuel Ivers | 4 of 51 | 7.8% | $343.14 |
| Jordan Blake, PA-C | 2 of 2 | 100.0% | $317.00 |
| Dr. Alana Reyes | 3 of 45 | 6.7% | $269.34 |
| Dr. Tomas Varga | 1 of 22 | 4.5% | $259.60 |
| Dr. Victor Adeyemi | 0 of 1 | 0.0% | $0.00 |
| Maya Chen, NP | 0 of 1 | 0.0% | $0.00 |
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 |
|---|---|---|---|
| Stonebridge | 9 of 71 | 12.7% | $1,748.60 |
| 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 |
|---|---|---|---|---|
| 50 Not medically necessary | The payer decided the service was not medically necessary. | Appeal with the visit note and any supporting records. | 6 | $1,099.40 |
| 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 |
| 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 |
| 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). | 1 | $283.20 |
| 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 |
| 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 |
| 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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