Claim CLM-2026-9100
Patient
- Name
- Teodora Petrova
- Date of birth
- 1983-03-24
- Patient id
- P048
Payer
- Name
- BCBS
- Payer id code
- 00210
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jan 30 (denial date, no service date on file)
- Procedure
- 97140, Manual Therapy, 15 min
- Diagnosis code
- M54.2
- Billed amount
- $1,285
Denial
- Reason
- Medical Necessity, code 50
- Date
- Jan 30
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.