Claim CLM-2024-8658
Patient
- Name
- Thea Lindgren
- Date of birth
- 1981-12-15
- Patient id
- H020
Payer
- Name
- Medicaid
- Payer id code
- 77043
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 18 (denial date, no service date on file)
- Procedure
- 58150, Hysterectomy
- Diagnosis code
- N80.0
- Billed amount
- $16,200
Denial
- Reason
- Not Covered, code 96
- Date
- Mar 18
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.