Heron

Elliot Marchetti

CLM-2026-9101, Aetna, MRI Lumbar Spine w/o Contrast (72148)

Written offWith me Denied claims
Billed
$1,743
denied Jan 2
Denial risk
75%
a hard one, worth it
Appeal window
closed
nothing left to file
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Entered by hand
    Jan 2
  2. Denied by Aetna
    Medical Necessity (50)
    Jan 2
  3. Heron scored it: 75% denial risk
    3 factors found, appeal path chosen
    Jan 2
  4. Heron
    Written off
    Every route exhausted
    Feb 16

The denial

Medical Necessity, code 50

Patient
Elliot Marchetti, born 1993-12-27
Payer
Aetna
Procedure
MRI Lumbar Spine w/o Contrast (72148)
Diagnosis
M51.16
Denied on
Jan 2, 2026
Assigned to
Heron
Heron says
High recovery risk (75), prioritize this claim in the appeal queue. Aetna denies 38% of 72148 claims without documented conservative treatment. Clinical notes supporting medical necessity were not attached to the original submission.

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

  • Clinical notes
  • Operative report

Everything I know about Elliot

across every queue
Everything for this patient
Open exposure
$44,591
Recovered
$0
5 denied claims3 prior auths2 underpayments3 backlog claims
AUTH-4080
70553 · MRI Brain w/ and w/o Contrast
52% odds
Approved
Aug 28
AUTH-4038
96417 · Chemotherapy, Additional Sequential
72% odds
Approved
Aug 25
AUTH-4029
70553 · MRI Brain w/ and w/o Contrast
62% odds
Pending
Aug 19
CLM-2026-5080
73721 · 11d outstanding
$3,828
Pending payer
Aug 19
CLM-2026-7039
70553 · underpaid 33.1%
$519 short
Disputed
Jun 27
CLM-2026-9032
96417 · Not Covered
$9,711
Denied
Jun 26
CLM-2026-9158
73721 · Medical Necessity
$3,899
In appeal
Jun 6
CLM-2026-9022
70553 · Duplicate Claim
$1,531
In review
May 15
CLM-2026-5085
93000 · 118d outstanding
$1,562
In follow up
May 4
CLM-2026-5027
93306 · 126d outstanding
$3,505
In follow up
Apr 26
CLM-2026-9104
96417 · Missing Information
$20,036
In appeal
Mar 7
CLM-2026-7088
70553 · underpaid 12.2%
$468 short
Written off
Mar 1
CLM-2026-9101viewing
72148 · Medical Necessity
$1,743
Written off
Jan 2