Claim CLM-2026-9104
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
- Mar 7 (denial date, no service date on file)
- Procedure
- 96417, Chemotherapy, Additional Sequential
- Diagnosis code
- C18.9
- Billed amount
- $20,036
Denial
- Reason
- Missing Information, code 16
- Date
- Mar 7
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.