Claim CLM-2024-8750
Patient
- Name
- Gwen Llewellyn
- Date of birth
- 1979-04-17
- Patient id
- H008
Payer
- Name
- Cigna
- Payer id code
- 62308
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 25 (denial date, no service date on file)
- Procedure
- 93015, Cardiac Stress Test
- Diagnosis code
- I25.10
- Billed amount
- $3,800
Denial
- Reason
- Medical Necessity, code 50
- Date
- Mar 25
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.