Wesley Okonkwo

CLM-2024-8635, Cigna, Knee Arthroscopy (29881)

In appealWith the payer Denied claims

Billed

$13,500

denied Apr 5

Denial risk

48%

good odds

Appeal window

lapsed

closes May 5

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Apr 5
Denied by Cigna
Medical Necessity (50)
Apr 5
Heron scored it: 48% denial risk
3 factors found, appeal path chosen
Apr 5

The denial

Medical Necessity, code 50

Patient: Wesley Okonkwo, born 1987-06-28
Payer: Cigna
Procedure: Knee Arthroscopy (29881)
Diagnosis: M23.61
Denied on: Apr 5, 2026
Assigned to: Heron

Heron says

Cigna requires MRI confirmation and documented physical therapy trial. 48% of similar denials are overturned with complete conservative treatment records. Include 3-month physical therapy notes and recent MRI findings.

No appeal yet

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What I sent

Clinical notes
Operative report

Everything I know about Wesley

across every queue

Everything for this patient

Open exposure

$13,500

Recovered

1 denied claim1 prior auth0 underpayments0 backlog claims

CLM-2024-8635viewing

29881 · Medical Necessity

27130 · Hip Replacement Surgery

58% odds

Expired

Apr 5