Claim CLM-2024-8847
Patient
- Name
- Zane Whitaker
- Date of birth
- 1968-03-14
- Patient id
- H001
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Apr 28 (denial date, no service date on file)
- Procedure
- 27447, Total Knee Replacement
- Diagnosis code
- M17.11
- Billed amount
- $24,500
Denial
- Reason
- Medical Necessity, code 50
- Date
- Apr 28
Appeal
- Status
- submitted
- Tracking id
- APP-2024-1122
- Submitted
- Apr 30
Prepared by Heron on Aug 30.