Claim CLM-2026-9105
Patient
- Name
- Oscar Lindqvist
- Date of birth
- 1995-12-13
- Patient id
- P047
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jul 2 (denial date, no service date on file)
- Procedure
- 93000, Electrocardiogram, Complete
- Diagnosis code
- R00.2
- Billed amount
- $5,083
Denial
- Reason
- Timely Filing, code 29
- Date
- Jul 2
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.