Claim CLM-2024-8710
Patient
- Name
- Liam Brennan
- Date of birth
- 1962-07-07
- Patient id
- H013
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 10 (denial date, no service date on file)
- Procedure
- 92920, Coronary Angioplasty
- Diagnosis code
- I25.10
- Billed amount
- $48,000
Denial
- Reason
- Medical Necessity, code 50
- Date
- Mar 10
Appeal
- Status
- submitted
- Tracking id
- APP-2024-1055
- Submitted
- Mar 15
Prepared by Heron on Aug 30.