Claim CLM-G0117126
$446.09
billed
$326.45
allowed
$0.00
paid
$0.00
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Preventive visit, established patient | 99396 | $226.36 | $0.00 |
| Hemoglobin A1c | 83036 | $31.01 | $0.00 |
| Office visit, established patient, level 4 | 99214 | $188.72 | $0.00 |
Denial risk — 9/99
Scored by the denial-risk model before adjudication. Advisory only — nothing blocks on a score; the factors below cite the adjudication history they came from.
| Factor | Weight |
|---|---|
| Aetna denial history: 599 of 6897 claims denied (9%) | -0.05 |
| Service 99214 (Office visit, established patient, level): 559 of 5916 historically denied (9%) | +0.01 |