Claim CLM-2024-8701
Patient
- Name
- Margot Beaulieu
- Date of birth
- 1977-03-31
- Patient id
- H014
Payer
- Name
- BCBS
- Payer id code
- 00210
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 8 (denial date, no service date on file)
- Procedure
- 58150, Hysterectomy
- Diagnosis code
- N80.0
- Billed amount
- $18,500
Denial
- Reason
- Medical Necessity, code 50
- Date
- Mar 8
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.