Denial & Appeals Assistant · demo

Denied claims

Remittance

835 · remit 2026-10-16

Member: Synthetic M-71442, 52 F, Commercial HMO (sample)
Provider: Riverbend Primary Care, Internal medicine
Service date: 2025-07-14
Claim no.: 26273-002950

Ln	Code	Billed	Paid	Denial
1	99396 Preventive visit, age 40-64	$245.00	$0.00	CO-29
2	36415 Routine venipuncture	$18.00	$0.00	CO-29

CO-29 Contractual obligation: the provider can't bill the member for this amount. The time limit for filing the claim has expired.

Claim submission history (practice billing system)

sub-1 · 2026-10-20

Patient: Linda Okoye   DOB: 09/03/1973   Account: 00266190

2025-07-18  Claim sent to clearinghouse, batch 7731.
2025-07-22  277CA received from plan: claim accepted for adjudication. Payer claim control number 25203-114872.
2025-12-09  Status inquiry: plan reports no claim on file under 25203-114872.
2026-09-30  Claim resubmitted after follow-up; plan assigned new claim number 26273-002950.
2026-10-16  Remittance: lines 1 and 2 denied, CARC 29.

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Synthetic claims and illustrative payment policies. Code meanings are paraphrased from the X12 code lists.