Claim CLM-2024-8741
Patient
- Name
- Hiro Sato
- Date of birth
- 1955-08-30
- Patient id
- H009
Payer
- Name
- Medicare
- Payer id code
- 00882
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Mar 22 (denial date, no service date on file)
- Procedure
- 27447, Total Knee Replacement
- Diagnosis code
- M17.11
- Billed amount
- $26,800
Denial
- Reason
- Medical Necessity, code 50
- Date
- Mar 22
Appeal
- Status
- under review
- Tracking id
- APP-2024-1070
- Submitted
- Mar 28
Prepared by Heron on Aug 30.