Claim CLM-2024-8725
Patient
- Name
- Jasper Kane
- Date of birth
- 1990-02-14
- Patient id
- H011
Payer
- Name
- BCBS
- Payer id code
- 00210
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 15 (denial date, no service date on file)
- Procedure
- 70553, Brain MRI with Contrast
- Diagnosis code
- G43.909
- Billed amount
- $5,200
Denial
- Reason
- Not Covered, code 96
- Date
- Mar 15
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.