Claim CLM-2024-8688
Patient
- Name
- Odalys Pena
- Date of birth
- 1969-06-25
- Patient id
- H016
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 2 (denial date, no service date on file)
- Procedure
- 93015, Cardiac Stress Test
- Diagnosis code
- I25.10
- Billed amount
- $2,800
Denial
- Reason
- Medical Necessity, code 50
- Date
- Mar 2
Appeal
- Status
- approved
- Tracking id
- APP-2024-1040
- Submitted
- Mar 5
Prepared by Heron on Aug 30.