Claim CLM-2024-8733
Patient
- Name
- Imani Baptiste
- Date of birth
- 1973-05-09
- Patient id
- H010
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 18 (denial date, no service date on file)
- Procedure
- 22612, Spinal Fusion L3-L4
- Diagnosis code
- M51.16
- Billed amount
- $42,000
Denial
- Reason
- Pre-Auth Missing, code 197
- Date
- Mar 18
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.