Heron

Kavya Pillai

CLM-2024-8718, Humana, Knee Arthroscopy (29881)

DeniedWith me Denied claims
Billed
$14,800
denied Mar 12
Denial risk
35%
good odds
Appeal window
lapsed
closes Apr 12
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Mar 12
  2. Denied by Humana
    Bundling/Coding Error (97)
    Mar 12
  3. Heron
    Heron scored it: 35% denial risk
    3 factors found, appeal path chosen
    Mar 12
  4. Appeal window lapsed
    140 days ago
    Apr 12

The denial

Bundling/Coding Error, code 97

Patient
Kavya Pillai, born 1986-10-23
Payer
Humana
Procedure
Knee Arthroscopy (29881)
Diagnosis
M23.61
Denied on
Mar 12, 2026
Assigned to
Heron
Heron says
Humana flagged possible unbundling, verify modifier usage on claim lines. Low complexity denial, 80% of bundling errors resolved with corrected coding. Review NCCI edits for CPT 29881 modifier requirements.

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What I sent

  • Corrected claim

Everything I know about Kavya

across every queue
Everything for this patient
Open exposure
$14,800
Recovered
$0
1 denied claim0 prior auths0 underpayments0 backlog claims
CLM-2024-8718viewing
29881 ยท Bundling/Coding Error
$14,800
Denied
Mar 12