Samuel Adeyemi

CLM-2024-8665, Humana, Coronary Angioplasty (92920)

In appealWith the payer Denied claims

Billed

$36,000

denied Mar 20

Denial risk

51%

good odds

Appeal window

lapsed

closes May 20

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Mar 20
Denied by Humana
Medical Necessity (50)
Mar 20
Heron scored it: 51% denial risk
3 factors found, appeal path chosen
Mar 20

The denial

Medical Necessity, code 50

Patient: Samuel Adeyemi, born 1966-04-02
Payer: Humana
Procedure: Coronary Angioplasty (92920)
Diagnosis: I25.10
Denied on: Mar 20, 2026
Assigned to: Heron

Heron says

Humana requires evidence of failed medical management for interventional procedures. Include cardiac catheterization report and medication trial documentation. Peer-to-peer review recommended for expedited resolution.

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What I sent

Clinical notes
Operative report

Everything I know about Samuel

across every queue

Everything for this patient

Open exposure

$36,000

Recovered

1 denied claim1 prior auth0 underpayments0 backlog claims

AUTH-3279

92920 · Coronary Angioplasty

92920 · Medical Necessity

$36,000

In appeal

Mar 20