Claim CLM-2024-8672
Patient
- Name
- Rhea Chaudhary
- Date of birth
- 1993-08-08
- Patient id
- H018
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 28 (denial date, no service date on file)
- Procedure
- 70553, Brain MRI with Contrast
- Diagnosis code
- G43.909
- Billed amount
- $5,400
Denial
- Reason
- Timely Filing, code 29
- Date
- Mar 28
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.