Heron

Valentina Ruiz

CLM-2024-8642, BCBS, Cardiac Stress Test (93015)

RecoveredWith me Denied claims
Billed
$3,600
denied Mar 30
Denial risk
15%
good odds
Appeal window
closed
nothing left to file
Recovered
$3,600
the money is back

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Mar 30
  2. Denied by BCBS
    Bundling/Coding Error (97)
    Mar 30
  3. Heron scored it: 15% denial risk
    3 factors found, appeal path chosen
    Mar 30
  4. Heron
    Paid in full
    The money is back
    Apr 10

The denial

Bundling/Coding Error, code 97

Patient
Valentina Ruiz, born 1974-09-12
Payer
BCBS
Procedure
Cardiac Stress Test (93015)
Diagnosis
I25.10
Denied on
Mar 30, 2026
Assigned to
Heron

Resolved via corrected coding

Heron says
BCBS flagged modifier issue, easily corrected with proper modifier application. Low risk, 92% of similar coding corrections are approved on resubmission. Verify modifier 26 vs TC usage for professional vs technical component.

No appeal yet

I can draft one from this claim's history

View the claim form

This claim is settled, so there is nothing left to write.

What I sent

  • Corrected claim

Everything I know about Valentina

across every queue
Everything for this patient
Open exposure
$0
Recovered
$3,600
1 denied claim0 prior auths0 underpayments0 backlog claims
CLM-2024-8642viewing
93015 ยท Bundling/Coding Error
$3,600
Recovered
Mar 30