Fatima Zahra

CLM-2026-9122, BCBS, Chemotherapy Infusion, 1st Hour (96413)

In appealWith the payer Denied claims

Billed

$12,366

denied Aug 3

Denial risk

57%

winnable with the right notes

Appeal window

63d

closes Nov 1

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Aug 3
Denied by BCBS
Medical Necessity (50)
Aug 3
Heron scored it: 57% denial risk
3 factors found, appeal path chosen
Aug 3

The denial

Medical Necessity, code 50

Patient: Fatima Zahra, born 1972-05-30
Payer: BCBS
Procedure: Chemotherapy Infusion, 1st Hour (96413)
Diagnosis: C50.911
Denied on: Aug 3, 2026
Assigned to: Heron

Heron says

BCBS denies 60% of 96413 claims without documented conservative treatment. Clinical notes supporting medical necessity were not attached to the original submission. Attach treatment history and imaging before appealing, overturn rate rises sharply with documentation.