Claim CLM-2026-9101
Patient
- Name
- Elliot Marchetti
- Date of birth
- 1993-12-27
- Patient id
- P050
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jan 2 (denial date, no service date on file)
- Procedure
- 72148, MRI Lumbar Spine w/o Contrast
- Diagnosis code
- M51.16
- Billed amount
- $1,743
Denial
- Reason
- Medical Necessity, code 50
- Date
- Jan 2
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.