Payers / Tallow Creek Health Plan
Tallow Creek Health Plan
Commercial. Payer ID 99901. Appeals within 90 days of the remittance; claims within 90 days of the visit.
Payments dated Aug 23, 2026 to Sep 21, 2026, as of Oct 6, 2026. Whole organization, every site.
Received
$40,867.80
2 payments
Denial rate
10.1%
14 of 138 claims
Underpaid
$68.90
Below the contract rate
Days to pay
19
Average, sent to paid
Open work (15)
| Claim | Result | At stake |
|---|---|---|
| RHP100104 | Partially denied | $84.50 |
| RHP100105 | Underpaid | $68.90 |
| RHP100106 | Partially denied | $84.50 |
| RHP100107 | Paid as expected | $0.00 |
| RHP100108 | Denied | $214.50 |
| RHP100143 | Denied | $84.50 |
| RHP100302 | Denied | $167.70 |
| RHP100315 | Denied | $1,365.00 |
| RHP100328 | Denied | $145.60 |
| RHP100341 | Denied | $1,885.00 |
| RHP100705 | Denied | $936.00 |
| RHP100718 | Denied | $167.70 |
| RHP100731 | Denied | $1,365.00 |
| RHP100744 | Denied | $145.60 |
| RHP100757 | Denied | $1,885.00 |
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Denial reasons
| Reason | Claims | At stake |
|---|---|---|
| 27 After coverage ended | 2 | $3,770.00 |
| 197 Prior authorization missing | 4 | $2,899.00 |
| 50 Not medically necessary | 1 | $936.00 |
| 22 Another payer may be primary | 2 | $335.40 |
| 4 Modifier does not fit the code | 2 | $291.20 |
| 16 Missing or invalid information | 1 | $214.50 |
| 18 Exact duplicate | 1 | $172.90 |
| 97 Bundled into another service | 1 | $84.50 |
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Payments
| Paid | Trace number | Amount |
|---|---|---|
| Aug 23, 2026 | EFT9990000411 | $21,792.88 |
| Sep 21, 2026 | EFT9990000498 | $19,074.92 |
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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 | $130.00 |
| 20610 | Large joint injection | $84.50 |
| 27447 | Total knee replacement | $1,885.00 |
| 29827 | Shoulder arthroscopy, rotator cuff repair | $1,365.00 |
| 29881 | Knee arthroscopy with meniscectomy | $936.00 |
| 36415 | Blood draw | $3.90 |
| 45380 | Colonoscopy with biopsy | $494.00 |
| 64483 | Epidural steroid injection, lumbar | $312.00 |
| 71046 | Chest x-ray, two views | $45.50 |
| 73721 | MRI of a leg joint | $338.00 |
| 80053 | Metabolic panel | $14.30 |
| 85025 | Complete blood count | $10.40 |
| 90471 | Vaccine administration | $22.10 |
| 90686 | Flu vaccine | $26.00 |
| 93000 | Electrocardiogram | $22.10 |
| 93306 | Echocardiogram, complete | $286.00 |
| 97110 | Therapeutic exercise, 15 minutes | $37.70 |
| 99203 | New patient visit, low complexity | $145.60 |
| 99204 | New patient visit, moderate complexity | $221.00 |
| 99213 | Established patient visit, low complexity | $119.60 |
| 99214 | Established patient visit, moderate complexity | $169.00 |
| 99215 | Established patient visit, high complexity | $237.90 |
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