Claim CLM-2026-9115
Patient
- Name
- Marcus Oyelaran
- Date of birth
- 2001-10-13
- Patient id
- P010
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Aug 24 (denial date, no service date on file)
- Procedure
- 72110, X-Ray Lumbar Spine, 4+ Views
- Diagnosis code
- M54.51
- Billed amount
- $2,041
Denial
- Reason
- Medical Necessity, code 50
- Date
- Aug 24
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.