Heron

Bruno Ferreira

CLM-2024-8819, BCBS, Hip Arthroplasty (27447)

In reviewWith you Denied claims
Billed
$29,100
denied Apr 15
Denial risk
41%
good odds
Appeal window
lapsed
closes May 15
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Apr 15
  2. Denied by BCBS
    Bundling/Coding Error (97)
    Apr 15
  3. Heron
    Heron scored it: 41% denial risk
    3 factors found, appeal path chosen
    Apr 15
  4. Appeal window lapsed
    107 days ago
    May 15

The denial

Bundling/Coding Error, code 97

Patient
Bruno Ferreira, born 1959-11-03
Payer
BCBS
Procedure
Hip Arthroplasty (27447)
Diagnosis
M17.11
Denied on
Apr 15, 2026
Assigned to
Heron
Heron says
BCBS flagged potential bundling issue with modifier usage on claim line items. 50% of similar claims resolved by resubmission with corrected modifier codes. Review operative notes to ensure procedures are reported independently.

No appeal yet

I can draft one from this claim's history

Draft itView the claim form

Open Intelligence, pick this claim, and I write the letter from the denial, the payer's rules and the clinical guideline. You sign it here.

What I sent

  • Corrected claim

Everything I know about Bruno

across every queue
Everything for this patient
Open exposure
$29,100
Recovered
$0
1 denied claim1 prior auth0 underpayments0 backlog claims
AUTH-3237
93015 · Cardiac Stress Test
90% odds
Pending
Apr 27
CLM-2024-8819viewing
27447 · Bundling/Coding Error
$29,100
In review
Apr 15