Claim CLM-2024-8831
Patient
- Name
- Amara Diallo
- Date of birth
- 1975-07-22
- Patient id
- H002
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Apr 22 (denial date, no service date on file)
- Procedure
- 22612, Spinal Fusion L4-L5
- Diagnosis code
- M51.16
- Billed amount
- $38,200
Denial
- Reason
- Pre-Auth Missing, code 197
- Date
- Apr 22
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.