Leila Haddad

CLM-2026-9010, BCBS, Chemotherapy Infusion, 1st Hour (96413)

In appealWith the payer Denied claims

Billed

$9,550

denied Jul 21

Denial risk

82%

a hard one, worth it

Appeal window

50d

closes Oct 19

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Imported from a CSV export
Jul 21
Denied by BCBS
Coverage Terminated (27)
Jul 21
Heron scored it: 82% denial risk
3 factors found, appeal path chosen
Jul 21

The denial

Coverage Terminated, code 27

Patient: Leila Haddad, born 1964-12-23
Payer: BCBS
Procedure: Chemotherapy Infusion, 1st Hour (96413)
Diagnosis: C50.911
Denied on: Jul 21, 2026
Assigned to: Heron

Heron says

High recovery risk (82), prioritize this claim in the appeal queue. Coverage had terminated as of the date of service per BCBS eligibility. Re-run eligibility for the service date and check for a successor plan.

No appeal yet

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Draft it View the claim form

Open Intelligence, pick this claim, and I write the letter from the denial, the payer's rules and the clinical guideline. You sign it here.

What I sent

Nothing sent yet.

Everything I know about Leila

across every queue

Everything for this patient

Open exposure

$31,647

Recovered

$7,415

4 denied claims1 prior auth4 underpayments7 backlog claims

AUTH-4018

96413 · Chemotherapy Infusion, 1st Hour

93306 · 3d outstanding

93306 · 3d outstanding

93000 · Medical Necessity

72110 · 29d outstanding

96417 · 37d outstanding

96413 · Bundling/Coding Error

96413 · Coverage Terminated

93015 · 44d outstanding

72110 · 64d outstanding

96417 · 102d outstanding

93000 · underpaid 23.1%

93306 · underpaid 6.7%

93015 · underpaid 17%

96413 · underpaid 24.4%

$626 short

Recovered

Sep 17