Desmond Achebe

CLM-2026-9108, Medicare, Therapeutic Exercise, 15 min (97110)

RecoveredWith me Denied claims

Billed

$1,866

denied Feb 12

Denial risk

94%

a hard one, worth it

Appeal window

closed

nothing left to file

Recovered

$1,866

the money is back

What I did

and what comes next

Claim reached Heron
Imported from a CSV export
Feb 12
Denied by Medicare
Coverage Terminated (27)
Feb 12
Heron scored it: 94% denial risk
3 factors found, appeal path chosen
Feb 12
Paid in full
The money is back
May 4

The denial

Coverage Terminated, code 27

Patient: Desmond Achebe, born 1960-06-23
Payer: Medicare
Procedure: Therapeutic Exercise, 15 min (97110)
Diagnosis: M25.561
Denied on: Feb 12, 2026
Assigned to: Heron

Appeal successful, payment posted

Heron says

High recovery risk (94), prioritize this claim in the appeal queue. Coverage had terminated as of the date of service per Medicare eligibility. Re-run eligibility for the service date and check for a successor plan.

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

Nothing sent yet.

Everything I know about Desmond

across every queue

Everything for this patient

Open exposure

$16,910

Recovered

$16,885

9 denied claims1 prior auth5 underpayments3 backlog claims

CLM-2026-7007

97530 · underpaid 8.5%

96413 · Chemotherapy Infusion, 1st Hour

93000 · Medical Necessity

97530 · underpaid 21.7%

96413 · 13d outstanding

97530 · Pre-Auth Missing

93306 · underpaid 31.4%

97530 · 72d outstanding

73630 · 134d outstanding

73630 · Missing Information

97530 · Bundling/Coding Error

96417 · Bundling/Coding Error

97110 · Coverage Terminated

73630 · Medical Necessity

93000 · underpaid 27.3%

97110 · Medical Necessity

97110 · underpaid 27.9%

$159 short

Recovered

Nov 1