Heron

Nikolai Sorokin

CLM-2024-8695, Cigna, Total Knee Replacement (27447)

DeniedWith me Denied claims
Billed
$25,600
denied Mar 5
Denial risk
78%
a hard one, worth it
Appeal window
lapsed
closes Apr 5
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Mar 5
  2. Denied by Cigna
    Pre-Auth Missing (197)
    Mar 5
  3. Heron
    Heron scored it: 78% denial risk
    3 factors found, appeal path chosen
    Mar 5
  4. Appeal window lapsed
    147 days ago
    Apr 5

The denial

Pre-Auth Missing, code 197

Patient
Nikolai Sorokin, born 1984-11-19
Payer
Cigna
Procedure
Total Knee Replacement (27447)
Diagnosis
M17.11
Denied on
Mar 5, 2026
Assigned to
Heron
Heron says
Cigna requires prior authorization for all total joint replacements. Retroactive authorization may be available, contact Cigna within 30 days. Include surgical necessity documentation with retroactive auth request.

No appeal yet

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What I sent

  • Referral on file

Everything I know about Nikolai

across every queue
Everything for this patient
Open exposure
$25,600
Recovered
$0
1 denied claim1 prior auth0 underpayments0 backlog claims
AUTH-3304
93015 · Cardiac Stress Test
92% odds
Approved
May 9
CLM-2024-8695viewing
27447 · Pre-Auth Missing
$25,600
Denied
Mar 5