Claim CLM-2024-8680
Patient
- Name
- Patrick Ashworth
- Date of birth
- 1957-01-12
- Patient id
- H017
Payer
- Name
- Medicare
- Payer id code
- 00882
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 1 (denial date, no service date on file)
- Procedure
- 22612, Spinal Fusion L5-S1
- Diagnosis code
- M51.16
- Billed amount
- $44,500
Denial
- Reason
- Medical Necessity, code 50
- Date
- Mar 1
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.