Claim CLM-2024-8635
Patient
- Name
- Wesley Okonkwo
- Date of birth
- 1987-06-28
- Patient id
- H023
Payer
- Name
- Cigna
- Payer id code
- 62308
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Apr 5 (denial date, no service date on file)
- Procedure
- 29881, Knee Arthroscopy
- Diagnosis code
- M23.61
- Billed amount
- $13,500
Denial
- Reason
- Medical Necessity, code 50
- Date
- Apr 5
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.