Claim CLM-2024-8695
Patient
- Name
- Nikolai Sorokin
- Date of birth
- 1984-11-19
- Patient id
- H015
Payer
- Name
- Cigna
- Payer id code
- 62308
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 5 (denial date, no service date on file)
- Procedure
- 27447, Total Knee Replacement
- Diagnosis code
- M17.11
- Billed amount
- $25,600
Denial
- Reason
- Pre-Auth Missing, code 197
- Date
- Mar 5
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.