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; site Jefferson Park, Eastgate Family Care, Stonebridge or Riverside Orthopedics.
Denial rate
8.3%
9 of 109 claims, fully or partly
Refused
$1,732.90
Valued at the contract rate
Preventable before the visit
66.7%
$1,479.40: eligibility, authorization, payer order, enrollment
Codes in play
4
Distinct primary reasons
By kind of problem
- Prior authorization Front end5 · $1,326.00
- Eligibility Front end1 · $153.40
- Duplicate 1 · $153.40
- Bundled into another service 1 · $84.50
By payer
| Payer | Denied | Rate | Refused |
|---|---|---|---|
| Fernhollow Community Care | 3 of 22 | 13.6% | $421.20 |
| Granite Plains Mutual | 5 of 36 | 13.9% | $1,227.20 |
| Silver Mesa Senior Advantage | 0 of 24 | 0.0% | $0.00 |
| Tallow Creek Health Plan | 1 of 27 | 3.7% | $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. Owen Whitaker | 2 of 32 | 6.3% | $509.60 |
| Jordan Blake, PA-C | 2 of 36 | 5.6% | $509.60 |
| Dr. Alana Reyes | 4 of 7 | 57.1% | $406.90 |
| Dr. Victor Adeyemi | 1 of 33 | 3.0% | $306.80 |
| Dr. Tomas Varga | 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 |
|---|---|---|---|
| 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 |
| 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 | $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 |
| 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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