Heron

Desmond Achebe

CLM-2026-9119, Medicare, Therapeutic Activities, 15 min (97530)

DeniedWith me Denied claims
Billed
$1,828
denied Aug 9
Denial risk
69%
winnable with the right notes
Appeal window
69d
closes Nov 7
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Entered by hand
    Aug 9
  2. Denied by Medicare
    Pre-Auth Missing (197)
    Aug 9
  3. Heron
    Heron scored it: 69% denial risk
    3 factors found, appeal path chosen
    Aug 9
  4. Appeal window closes
    69 days left to file
    Nov 7

The denial

Pre-Auth Missing, code 197

Patient
Desmond Achebe, born 1960-06-23
Payer
Medicare
Procedure
Therapeutic Activities, 15 min (97530)
Diagnosis
M62.81
Denied on
Aug 9, 2026
Assigned to
Heron
Heron says
Prior authorization was not on file at time of service, Medicare auto-denies 97530 without it. 7 similar denials at this facility in the last 90 days for the same reason. Retro-auth may be available within 30 days of service; escalate to the payer's auth desk.

No appeal yet

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What I sent

  • Referral on file

Everything I know about Desmond

across every queue
Everything for this patient
Open exposure
$16,910
Recovered
$16,885
9 denied claims1 prior auth5 underpayments3 backlog claims
CLM-2026-7007
97530 · underpaid 8.5%
$64 short
Under review
Aug 26
AUTH-4025
96413 · Chemotherapy Infusion, 1st Hour
79% odds
Pending
Aug 25
CLM-2026-9056
93000 · Medical Necessity
$3,018
Denied
Aug 22
CLM-2026-7002
97530 · underpaid 21.7%
$76 short
Disputed
Aug 20
CLM-2026-5015
96413 · 13d outstanding
$7,880
In follow up
Aug 17
CLM-2026-9119viewing
97530 · Pre-Auth Missing
$1,828
Denied
Aug 9
CLM-2026-7052
93306 · underpaid 31.4%
$189 short
Disputed
Aug 8
CLM-2026-9049
93306 · Not Covered
$2,771
In appeal
Jul 11
CLM-2026-5134
97530 · 72d outstanding
$701
Pending payer
Jun 19
CLM-2026-5010
73630 · 134d outstanding
$383
Partially paid
Apr 18
CLM-2026-9142
73630 · Missing Information
$481
Recovered
Apr 4
CLM-2026-9161
97530 · Bundling/Coding Error
$797
Written off
Mar 27
CLM-2026-9128
96417 · Bundling/Coding Error
$12,355
Recovered
Mar 19
CLM-2026-9108
97110 · Coverage Terminated
$1,866
Recovered
Feb 12
CLM-2026-9062
73630 · Medical Necessity
$596
Recovered
Feb 10
CLM-2026-7087
93000 · underpaid 27.3%
$553 short
Recovered
Jan 27
CLM-2025-9006
97110 · Medical Necessity
$875
Recovered
Dec 28
CLM-2025-7077
97110 · underpaid 27.9%
$159 short
Recovered
Nov 1