Claim CLM-2026-9120
Patient
- Name
- Beatriz Almeida
- Date of birth
- 1984-10-12
- Patient id
- P002
Payer
- Name
- BCBS
- Payer id code
- 00210
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- May 18 (denial date, no service date on file)
- Procedure
- 73630, X-Ray Foot, Complete
- Diagnosis code
- M79.671
- Billed amount
- $1,085
Denial
- Reason
- Medical Necessity, code 50
- Date
- May 18
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.