GHA $1$ Template

COLUMN A B C$=$A$-$B

PAYER FULL RATE CONTRACTED$$RATE CONTRACTUAL$$ALLOWANCE

FHP $$65\mathrm{.}00$ $$35\mathrm{.}56$

HPHP $$65\mathrm{.}00$ $$54\mathrm{.}68$

MC $$65\mathrm{.}00$ $$45\mathrm{.}19$

UND $$65\mathrm{.}00$ $$23\mathrm{.}40$

CCN $$65\mathrm{.}00$ $$37\mathrm{.}82$

Contractual Allowances

Physician office revenue for visit code $99214$ has a full established rate of $$65\mathrm{.}00.$

Of $5$ different payers, there are $5$ different contracted rates, as indicated in the template provided below.

For each payer, compute the contractual allowance using the template provided here. Download here.$($To download the file, click on the arrow next to the word "here"$).$