Claim CLM-2024-8776
Patient
- Name
- Esme Thornton
- Date of birth
- 1988-09-05
- Patient id
- H006
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Apr 3 (denial date, no service date on file)
- Procedure
- 29881, Knee Arthroscopy
- Diagnosis code
- M23.61
- Billed amount
- $12,400
Denial
- Reason
- Medical Necessity, code 50
- Date
- Apr 3
Appeal
- Status
- submitted
- Tracking id
- APP-2024-1098
- Submitted
- Apr 8
Prepared by Heron on Aug 30.