Claim CLM-2024-8605
Patient
- Name
- Dmitri Volkov
- Date of birth
- 1976-07-22
- Patient id
- H027
Payer
- Name
- Humana
- Payer id code
- 61101
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Apr 18 (denial date, no service date on file)
- Procedure
- 22612, Spinal Fusion L4-L5
- Diagnosis code
- M51.16
- Billed amount
- $39,500
Denial
- Reason
- Medical Necessity, code 50
- Date
- Apr 18
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.