Heron

Umberto Conti

CLM-2024-8650, Aetna, Brain MRI with Contrast (70553)

DeniedWith me Denied claims
Billed
$4,800
denied Apr 1
Denial risk
74%
winnable with the right notes
Appeal window
lapsed
closes May 1
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Apr 1
  2. Denied by Aetna
    Pre-Auth Missing (197)
    Apr 1
  3. Heron
    Heron scored it: 74% denial risk
    3 factors found, appeal path chosen
    Apr 1
  4. Appeal window lapsed
    121 days ago
    May 1

The denial

Pre-Auth Missing, code 197

Patient
Umberto Conti, born 1995-03-20
Payer
Aetna
Procedure
Brain MRI with Contrast (70553)
Diagnosis
G43.909
Denied on
Apr 1, 2026
Assigned to
Heron
Heron says
Aetna requires prior authorization for advanced imaging studies. Retroactive auth available within 14 days of service, submit immediately. Include referral from primary care and clinical justification.

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 Umberto

across every queue
Everything for this patient
Open exposure
$4,800
Recovered
$0
1 denied claim0 prior auths0 underpayments0 backlog claims
CLM-2024-8650viewing
70553 ยท Pre-Auth Missing
$4,800
Denied
Apr 1