Claim CLM-2024-8665
Patient
- Name
- Samuel Adeyemi
- Date of birth
- 1966-04-02
- Patient id
- H019
Payer
- Name
- Humana
- Payer id code
- 61101
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 20 (denial date, no service date on file)
- Procedure
- 92920, Coronary Angioplasty
- Diagnosis code
- I25.10
- Billed amount
- $36,000
Denial
- Reason
- Medical Necessity, code 50
- Date
- Mar 20
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.