Claim CLM-G0117164
$202.82
billed
$164.06
allowed
$0.00
paid
$0.00
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Complete blood count | 85025 | $29.04 | $0.00 |
| Physical therapy, therapeutic exercise | 97110 | $85.88 | $0.00 |
| Chest radiograph, 2 views | 71046 | $87.90 | $0.00 |
Denial risk — 11/99
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 |
|---|---|
| Blue Cross Blue Shield denial history: 888 of 8634 claims denied (10%) | -0.16 |
| Service 97110 (Physical therapy, therapeutic exercise): 998 of 5998 historically denied (17%) | +0.08 |