Claim CLM-2024-8762
Patient
- Name
- Farid Nasser
- Date of birth
- 1964-12-11
- Patient id
- H007
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 28 (denial date, no service date on file)
- Procedure
- 58150, Hysterectomy
- Diagnosis code
- N80.0
- Billed amount
- $9,800
Denial
- Reason
- Timely Filing, code 29
- Date
- Mar 28
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.