Heron

Adaeze Nwosu

CLM-2024-8628, UnitedHealthcare, Total Knee Replacement (27447)

DeniedWith me Denied claims
Billed
$27,500
denied Apr 8
Denial risk
70%
winnable with the right notes
Appeal window
lapsed
closes May 8
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Apr 8
  2. Denied by UnitedHealthcare
    Medical Necessity (50)
    Apr 8
  3. Heron
    Heron scored it: 70% denial risk
    3 factors found, appeal path chosen
    Apr 8
  4. Appeal window lapsed
    114 days ago
    May 8

The denial

Medical Necessity, code 50

Patient
Adaeze Nwosu, born 1970-11-04
Payer
UnitedHealthcare
Procedure
Total Knee Replacement (27447)
Diagnosis
M17.11
Denied on
Apr 8, 2026
Assigned to
Heron
Heron says
UHC requires Grade IV radiographic evidence and documented functional limitation. Include weight-bearing X-rays and validated outcome measure scores. 70% overturn rate when complete documentation is provided.

No appeal yet

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What I sent

  • Clinical notes
  • Operative report

Everything I know about Adaeze

across every queue
Everything for this patient
Open exposure
$27,500
Recovered
$0
1 denied claim0 prior auths0 underpayments0 backlog claims
CLM-2024-8628viewing
27447 ยท Medical Necessity
$27,500
Denied
Apr 8