Demonstration environment. Fictional organization, fictional payers, synthetic data throughout. No patient data. Changes you make stay in this browser only.
ParvinCorpPayer Remittance Bridge

Ridgeline Health Partners. Multi-specialty physician group, 6 sites, 14 providers. This demo covers 12 billing providers, 4 billing locations and 4 contracted payers.

Signed in as

Dana Whitfield, Billing Operations Lead. Imports remittance files, works denials and underpayments, and is the only role that can open a raw remittance file from a payer (835).

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OverviewThe numbers that matterWork queue (102)What to fix, by deadlineDenialsWhy money did not arriveAwaiting paymentBilled, no answer yetImport a fileCheck and load a payer's payment fileClaimsEvery claim and its resultRemittancesPayments receivedPayersContracts and performanceReason codesPlain language lookupOrganizationEntities, regions and sitesGuided tourFive minute walkthrough
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Payers / Fernhollow Community Care

Fernhollow Community Care

Medicaid managed care. Payer ID 99904. Appeals within 60 days of the remittance; claims within 120 days of the visit.

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Payments dated Aug 3, 2026 to Sep 14, 2026, as of Oct 6, 2026. Whole organization, every site.

Received
$25,388.22
2 payments
Denial rate
11.1%
12 of 108 claims
Underpaid
$0.00
Below the contract rate
Days to pay
18
Average, sent to paid

Open work (12)

ClaimResultAt stake
RHP100134Denied$132.60
RHP100135Partially denied$15.60
RHP100136Denied$45.24
RHP100201Denied$187.20
RHP100601Denied$171.60
RHP100614Denied$142.74
RHP100627Denied$202.80
RHP100640Denied$74.10
RHP101004Denied$45.24
RHP101017Denied$171.60
RHP101030Denied$142.74
RHP101043Denied$202.80

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Denial reasons

ReasonClaimsAt stake
50 Not medically necessary3$530.40
22 Another payer may be primary3$418.08
197 Prior authorization missing2$405.60
4 Modifier does not fit the code1$74.10
151 More services than the payer allows1$45.24
16 Missing or invalid information1$45.24

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Payments

PaidTrace numberAmount
Aug 3, 202699900004301$12,468.30
Sep 14, 202699900004410$12,919.92

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Contracted fee schedule

The allowed amount per unit this payer agreed to. Every payment is checked against it.

CodeServiceContract rate
20610Large joint injection$50.70
27447Total knee replacement$1,131.00
29827Shoulder arthroscopy, rotator cuff repair$819.00
29881Knee arthroscopy with meniscectomy$561.60
36415Blood draw$2.34
45380Colonoscopy with biopsy$296.40
64483Epidural steroid injection, lumbar$187.20
71046Chest x-ray, two views$27.30
73721MRI of a leg joint$202.80
80053Metabolic panel$8.58
85025Complete blood count$6.24
90471Vaccine administration$13.26
90686Flu vaccine$15.60
93000Electrocardiogram$13.26
93306Echocardiogram, complete$171.60
97110Therapeutic exercise, 15 minutes$22.62
99203New patient visit, low complexity$87.36
99204New patient visit, moderate complexity$132.60
99213Established patient visit, low complexity$71.76
99214Established patient visit, moderate complexity$101.40
99215Established patient visit, high complexity$142.74
11102Skin biopsyNot loaded

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Payments for codes with no rate loaded cannot be checked against the contract, and are flagged on the claim.