Claim CLM-2026-9110
Patient
- Name
- Simone Laurent
- Date of birth
- 1966-12-04
- Patient id
- P011
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Aug 14 (denial date, no service date on file)
- Procedure
- 96413, Chemotherapy Infusion, 1st Hour
- Diagnosis code
- C50.911
- Billed amount
- $9,781
Denial
- Reason
- Not Covered, code 96
- Date
- Aug 14
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.