Heron

Odalys Pena

CLM-2024-8688, Aetna, Cardiac Stress Test (93015)

RecoveredWith me Denied claims
Billed
$2,800
denied Mar 2
Denial risk
19%
good odds
Appeal window
closed
nothing left to file
Recovered
$2,800
the money is back

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Mar 2
  2. Denied by Aetna
    Medical Necessity (50)
    Mar 2
  3. Heron scored it: 19% denial risk
    3 factors found, appeal path chosen
    Mar 2
  4. Appeal filed
    Tracking APP-2024-1040
    Mar 5
  5. Aetna approved the appeal
    Mar 15
  6. Heron
    Paid in full
    The money is back
    Mar 15

The denial

Medical Necessity, code 50

Patient
Odalys Pena, born 1969-06-25
Payer
Aetna
Procedure
Cardiac Stress Test (93015)
Diagnosis
I25.10
Denied on
Mar 2, 2026
Assigned to
Heron

Recovered via resubmission

Heron says
Aetna has 91% approval rate for cardiac stress tests with coronary artery disease diagnosis. Low-risk denial, likely a processing error. Simple resubmission with clinical notes should resolve.

The appeal

Filed Mar 5, approved

View the claim form

Filed under tracking APP-2024-1040. I follow up with Aetna every 14 days until they answer, and the letter will sit here once it is on file.

What I sent

  • Clinical notesMar 5
  • Operative reportMar 5

Everything I know about Odalys

across every queue
Everything for this patient
Open exposure
$0
Recovered
$2,800
1 denied claim0 prior auths0 underpayments0 backlog claims
CLM-2024-8688viewing
93015 ยท Medical Necessity
$2,800
Recovered
Mar 2