Payers / Silver Mesa Senior Advantage
Silver Mesa Senior Advantage
Medicare Advantage. Payer ID 99903. Appeals within 60 days of the remittance; claims within 365 days of the visit. Payments carry the 2 percent federal sequestration reduction (CO-253), which is expected and never counted as an underpayment.
Payments dated Aug 12, 2026 to Sep 7, 2026, as of Oct 6, 2026. Whole organization, every site.
Received
$29,619.49
2 payments
Denial rate
9.2%
12 of 130 claims
Underpaid
$13.00
Below the contract rate
Days to pay
18
Average, sent to paid
Open work (13)
| Claim | Result | At stake |
|---|---|---|
| RHP100123 | Partially denied | $17.00 |
| RHP100125 | Denied | $170.00 |
| RHP100127 | Underpaid | $13.00 |
| RHP100221 | Denied | $147.00 |
| RHP100223 | Denied | $220.00 |
| RHP100510 | Denied | $129.00 |
| RHP100523 | Denied | $1,050.00 |
| RHP100536 | Denied | $112.00 |
| RHP100549 | Denied | $1,450.00 |
| RHP101108 | Denied | $100.00 |
| RHP101121 | Denied | $720.00 |
| RHP101134 | Denied | $129.00 |
| RHP101147 | Denied | $1,050.00 |
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Denial reasons
| Reason | Claims | At stake |
|---|---|---|
| 197 Prior authorization missing | 2 | $2,100.00 |
| 27 After coverage ended | 1 | $1,450.00 |
| 50 Not medically necessary | 3 | $957.00 |
| 185 Rendering provider not eligible | 2 | $317.00 |
| 22 Another payer may be primary | 2 | $258.00 |
| 4 Modifier does not fit the code | 1 | $112.00 |
| 16 Missing or invalid information | 1 | $100.00 |
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Payments
| Paid | Trace number | Amount |
|---|---|---|
| Aug 12, 2026 | SM9990031102 | $14,318.96 |
| Sep 7, 2026 | SM9990031177 | $15,300.53 |
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Contracted fee schedule
The allowed amount per unit this payer agreed to. Every payment is checked against it.
| Code | Service | Contract rate |
|---|---|---|
| 11102 | Skin biopsy | $100.00 |
| 20610 | Large joint injection | $65.00 |
| 27447 | Total knee replacement | $1,450.00 |
| 29827 | Shoulder arthroscopy, rotator cuff repair | $1,050.00 |
| 29881 | Knee arthroscopy with meniscectomy | $720.00 |
| 36415 | Blood draw | $3.00 |
| 45380 | Colonoscopy with biopsy | $380.00 |
| 64483 | Epidural steroid injection, lumbar | $240.00 |
| 71046 | Chest x-ray, two views | $35.00 |
| 73721 | MRI of a leg joint | $260.00 |
| 80053 | Metabolic panel | $11.00 |
| 85025 | Complete blood count | $8.00 |
| 90471 | Vaccine administration | $17.00 |
| 90686 | Flu vaccine | $20.00 |
| 93000 | Electrocardiogram | $17.00 |
| 93306 | Echocardiogram, complete | $220.00 |
| 97110 | Therapeutic exercise, 15 minutes | $29.00 |
| 99203 | New patient visit, low complexity | $112.00 |
| 99204 | New patient visit, moderate complexity | $170.00 |
| 99213 | Established patient visit, low complexity | $92.00 |
| 99214 | Established patient visit, moderate complexity | $130.00 |
| 99215 | Established patient visit, high complexity | $183.00 |
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