Claim CLM-2026-9010
Patient
- Name
- Leila Haddad
- Date of birth
- 1964-12-23
- Patient id
- P030
Payer
- Name
- BCBS
- Payer id code
- 00210
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jul 21 (denial date, no service date on file)
- Procedure
- 96413, Chemotherapy Infusion, 1st Hour
- Diagnosis code
- C50.911
- Billed amount
- $9,550
Denial
- Reason
- Coverage Terminated, code 27
- Date
- Jul 21
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.