Claim CLM-G0140940
$460.50
billed
$317.32
allowed
$0.00
paid
$0.00
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Electrocardiogram, routine | 93000 | $65.19 | $0.00 |
| Office visit, established patient, level 4 | 99214 | $143.07 | $0.00 |
| Preventive visit, established patient | 99396 | $252.24 | $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 |
|---|---|
| Medicaid denial history: 800 of 8709 claims denied (9%) | +0.01 |
| Service 99214 (Office visit, established patient, level): 559 of 5916 historically denied (9%) | +0.01 |