Heron

Paloma Reyes

CLM-2026-9102, Aetna, Chemotherapy Infusion, Addl Hour (96415)

DeniedWith me Denied claims
Billed
$13,501
denied Aug 19
Denial risk
50%
good odds
Appeal window
79d
closes Nov 17
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Entered by hand
    Aug 19
  2. Denied by Aetna
    Bundling/Coding Error (97)
    Aug 19
  3. Heron
    Heron scored it: 50% denial risk
    3 factors found, appeal path chosen
    Aug 19
  4. Appeal window closes
    79 days left to file
    Nov 17

The denial

Bundling/Coding Error, code 97

Patient
Paloma Reyes, born 1990-03-28
Payer
Aetna
Procedure
Chemotherapy Infusion, Addl Hour (96415)
Diagnosis
C34.90
Denied on
Aug 19, 2026
Assigned to
Heron
Heron says
Aetna bundled this line into a primary procedure billed the same day. Modifier review recommended, most bundling denials resolve on corrected resubmission. Verify NCCI edit pairs before resubmitting to avoid a second rejection.

No appeal yet

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What I sent

  • Corrected claim

Everything I know about Paloma

across every queue
Everything for this patient
Open exposure
$50,201
Recovered
$0
3 denied claims2 prior auths1 underpayment3 backlog claims
AUTH-4053
96417 · Chemotherapy, Additional Sequential
92% odds
Pending
Aug 28
AUTH-4058
96415 · Chemotherapy Infusion, Addl Hour
44% odds
Approved
Aug 24
CLM-2026-5043
96417 · 6d outstanding
$12,951
Pending payer
Aug 24
CLM-2026-5083
96415 · 8d outstanding
$10,613
In follow up
Aug 22
CLM-2026-9102viewing
96415 · Bundling/Coding Error
$13,501
Denied
Aug 19
CLM-2026-5137
96417 · 18d outstanding
$9,547
Pending payer
Aug 12
CLM-2026-9044
96415 · Missing Information
$3,108
Denied
Jun 21
CLM-2026-7038
97530 · underpaid 19.7%
$71 short
Under review
Jun 13
CLM-2026-9124
97110 · Pre-Auth Missing
$410
In appeal
Jan 29