Heron

Amara Diallo

CLM-2024-8831, UnitedHealthcare, Spinal Fusion L4-L5 (22612)

DeniedWith me Denied claims
Billed
$38,200
denied Apr 22
Denial risk
88%
a hard one, worth it
Appeal window
lapsed
closes May 22
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Apr 22
  2. Denied by UnitedHealthcare
    Pre-Auth Missing (197)
    Apr 22
  3. Heron
    Heron scored it: 88% denial risk
    3 factors found, appeal path chosen
    Apr 22
  4. Appeal window lapsed
    100 days ago
    May 22

The denial

Pre-Auth Missing, code 197

Patient
Amara Diallo, born 1975-07-22
Payer
UnitedHealthcare
Procedure
Spinal Fusion L4-L5 (22612)
Diagnosis
M51.16
Denied on
Apr 22, 2026
Assigned to
Heron
Heron says
Prior auth not on file, UHC auto-denies without active authorization number. Similar claims denied 4x in past 90 days at this facility for same reason. Obtain auth before scheduling; allow 5-7 business day lead time.

No appeal yet

I can draft one from this claim's history

Draft itView the claim form

Open Intelligence, pick this claim, and I write the letter from the denial, the payer's rules and the clinical guideline. You sign it here.

What I sent

  • Referral on file

Everything I know about Amara

across every queue
Everything for this patient
Open exposure
$38,200
Recovered
$0
1 denied claim0 prior auths0 underpayments0 backlog claims
CLM-2024-8831viewing
22612 ยท Pre-Auth Missing
$38,200
Denied
Apr 22