Claim CLM-2024-8628
Patient
- Name
- Adaeze Nwosu
- Date of birth
- 1970-11-04
- Patient id
- H024
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Apr 8 (denial date, no service date on file)
- Procedure
- 27447, Total Knee Replacement
- Diagnosis code
- M17.11
- Billed amount
- $27,500
Denial
- Reason
- Medical Necessity, code 50
- Date
- Apr 8
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.