Imani Baptiste

CLM-2024-8733, Aetna, Spinal Fusion L3-L4 (22612)

DeniedWith me Denied claims

Billed

$42,000

denied Mar 18

Denial risk

85%

a hard one, worth it

Appeal window

lapsed

closes Apr 18

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Mar 18
Denied by Aetna
Pre-Auth Missing (197)
Mar 18
Heron scored it: 85% denial risk
3 factors found, appeal path chosen
Mar 18
Appeal window lapsed
134 days ago
Apr 18

The denial

Pre-Auth Missing, code 197

Patient: Imani Baptiste, born 1973-05-09
Payer: Aetna
Procedure: Spinal Fusion L3-L4 (22612)
Diagnosis: M51.16
Denied on: Mar 18, 2026
Assigned to: Heron

Heron says

Aetna requires prior authorization for all spinal fusion procedures, none found on file. Retroactive auth request may be possible within 14 business days of service. Contact Aetna provider services at 1-888-632-3862 for retroactive auth process.

No appeal yet

I can draft one from this claim's history

Draft it View the claim form

Open Intelligence, pick this claim, and I write the letter from the denial, the payer's rules and the clinical guideline. You sign it here.

What I sent

Referral on file

Everything I know about Imani

across every queue

Everything for this patient

Open exposure

$42,000

Recovered

1 denied claim1 prior auth0 underpayments0 backlog claims

AUTH-3272

27447 · Total Knee Replacement

22612 · Pre-Auth Missing

$42,000

Denied

Mar 18