Claim CLM-2026-9122
Patient
- Name
- Fatima Zahra
- Date of birth
- 1972-05-30
- Patient id
- P040
Payer
- Name
- BCBS
- Payer id code
- 00210
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Aug 3 (denial date, no service date on file)
- Procedure
- 96413, Chemotherapy Infusion, 1st Hour
- Diagnosis code
- C50.911
- Billed amount
- $12,366
Denial
- Reason
- Medical Necessity, code 50
- Date
- Aug 3
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.