Claim CLM-2024-8620
Patient
- Name
- Bastian Keller
- Date of birth
- 1983-02-17
- Patient id
- H025
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Apr 12 (denial date, no service date on file)
- Procedure
- 58150, Hysterectomy
- Diagnosis code
- N80.0
- Billed amount
- $21,000
Denial
- Reason
- Medical Necessity, code 50
- Date
- Apr 12
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.