Heron

Luis Ortega

CLM-2025-9113, Aetna, Chest X-Ray, 2 Views (71046)

Written offWith me Denied claims
Billed
$769
denied Dec 26
Denial risk
64%
winnable with the right notes
Appeal window
closed
nothing left to file
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Dec 26
  2. Denied by Aetna
    Not Covered (96)
    Dec 26
  3. Heron scored it: 64% denial risk
    3 factors found, appeal path chosen
    Dec 26
  4. Heron
    Written off
    Every route exhausted
    Feb 26

The denial

Not Covered, code 96

Patient
Luis Ortega, born 1991-11-04
Payer
Aetna
Procedure
Chest X-Ray, 2 Views (71046)
Diagnosis
R05.9
Denied on
Dec 26, 2026
Assigned to
Heron
Heron says
Service is excluded under the member's current Aetna benefit plan. Verify benefits as of the date of service, plan may have changed mid-year. If non-covered is confirmed, route to patient responsibility rather than appeal.

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 Luis

across every queue
Everything for this patient
Open exposure
$12,136
Recovered
$0
3 denied claims1 prior auth0 underpayments3 backlog claims
AUTH-4027
96415 · Chemotherapy Infusion, Addl Hour
73% odds
Pending
Aug 29
CLM-2026-5101
73630 · 3d outstanding
$3,047
Pending payer
Aug 27
CLM-2026-5016
96415 · 4d outstanding
$4,920
Pending payer
Aug 26
CLM-2026-9129
73630 · Duplicate Claim
$2,482
In review
Jul 21
CLM-2026-5081
73630 · 74d outstanding
$588
Not submitted
Jun 17
CLM-2026-9036
93306 · Medical Necessity
$1,099
In appeal
Apr 8
CLM-2025-9113viewing
71046 · Not Covered
$769
Written off
Dec 26