Claim CLM-2026-9011

Patient

Name: Mateo Fuentes
Date of birth: 1999-02-05
Patient id: P037

Payer

Name: Cigna
Payer id code: 62308

Provider

Name: Northside Medical
NPI: 1982744321

Service

Date of service: Aug 8 (denial date, no service date on file)
Procedure: 70553, MRI Brain w/ and w/o Contrast
Diagnosis code: G43.909
Billed amount: $4,629

Denial

Reason: Duplicate Claim, code 18
Date: Aug 8

Appeal

Status: No appeal filed yet

Prepared by Heron on Aug 30.