Claim CLM-2026-9111
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
- Jan 2 (denial date, no service date on file)
- Procedure
- 96415, Chemotherapy Infusion, Addl Hour
- Diagnosis code
- C34.90
- Billed amount
- $19,443
Denial
- Reason
- Medical Necessity, code 50
- Date
- Jan 2
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.