Rosa Delgado

CLM-2026-9000, Cigna, MRI Lumbar Spine w/o Contrast (72148)

RecoveredWith me Denied claims

Billed

$5,495

denied Mar 17

Denial risk

76%

a hard one, worth it

Appeal window

closed

nothing left to file

Recovered

$5,495

the money is back

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Mar 17
Denied by Cigna
Pre-Auth Missing (197)
Mar 17
Heron scored it: 76% denial risk
3 factors found, appeal path chosen
Mar 17
Paid in full
The money is back
May 22

The denial

Pre-Auth Missing, code 197

Patient: Rosa Delgado, born 1966-08-14
Payer: Cigna
Procedure: MRI Lumbar Spine w/o Contrast (72148)
Diagnosis: M51.16
Denied on: Mar 17, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

High recovery risk (76), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, Cigna auto-denies 72148 without it. 2 similar denials at this facility in the last 90 days for the same reason.

No appeal yet

I can draft one from this claim's history

View the claim form

This claim is settled, so there is nothing left to write.

What I sent

Referral on file

Everything I know about Rosa

across every queue

Everything for this patient

Open exposure

$13,039

Recovered

$7,606

3 denied claims2 prior auths4 underpayments4 backlog claims

CLM-2026-9051

97110 · Pre-Auth Missing

73721 · underpaid 33.4%

72148 · MRI Lumbar Spine w/o Contrast

93015 · 21d outstanding

70553 · MRI Brain w/ and w/o Contrast

93306 · 94d outstanding

93015 · underpaid 14.3%

70553 · 113d outstanding

93306 · 121d outstanding

72148 · Pre-Auth Missing

97140 · Medical Necessity

73721 · underpaid 26.2%

72148 · underpaid 12.6%

$417 short

Recovered

Nov 15