X12 Ingest & Denial Analytics

Nothing withheld — $127.40 now rests with the patient

Billed $196.00. The payer paid $0.00, wrote off $68.60 under the contract, and assigned $127.40 to the patient. The $68.60 contractual write-off is not collectable from anyone — it is the discount the practice agreed with this payer. Nothing is modelled as recoverable from the payer: it withheld nothing on this claim. Non-covered charge. Read the RARC: some are appealable, most are not. Before billing the patient, confirm the balance against the remittance, check whether notice was given before the service, and check whether a secondary payer applies.

From: 835 CLP amounts and CAS adjustments on this claim; the denial derivation for the modelled recoverable amount and filing window.

Limits: Patient responsibility reported on an 835 is not revenue. This application cannot say whether the practice billed it, whether the patient paid, or whether a secondary payer covered it — those live in a billing system it does not read. The recoverable figure and the deadline are estimates, not a payer commitment.

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