Heron

Isabel Carvalho

CLM-2026-9123, UnitedHealthcare, Chemotherapy Infusion, 1st Hour (96413)

In appealWith the payer Denied claims
Billed
$8,885
denied Jun 27
Denial risk
51%
good odds
Appeal window
26d
closes Sep 25
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Entered by hand
    Jun 27
  2. Denied by UnitedHealthcare
    Bundling/Coding Error (97)
    Jun 27
  3. Heron
    Heron scored it: 51% denial risk
    3 factors found, appeal path chosen
    Jun 27

The denial

Bundling/Coding Error, code 97

Patient
Isabel Carvalho, born 1989-06-08
Payer
UnitedHealthcare
Procedure
Chemotherapy Infusion, 1st Hour (96413)
Diagnosis
C50.911
Denied on
Jun 27, 2026
Assigned to
Heron
Heron says
UnitedHealthcare bundled this line into a primary procedure billed the same day. Modifier review recommended, most bundling denials resolve on corrected resubmission. Verify NCCI edit pairs before resubmitting to avoid a second rejection.

No appeal yet

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What I sent

  • Corrected claim

Everything I know about Isabel

across every queue
Everything for this patient
Open exposure
$14,240
Recovered
$159
3 denied claims1 prior auth2 underpayments2 backlog claims
AUTH-4078
96417 · Chemotherapy, Additional Sequential
69% odds
Pending
Aug 30
CLM-2026-5151
71046 · 5d outstanding
$1,469
In follow up
Aug 25
CLM-2026-7037
96417 · underpaid 9.9%
$582 short
Under review
Aug 23
CLM-2026-9076
71046 · Medical Necessity
$1,413
Denied
Aug 7
CLM-2026-9123viewing
96413 · Bundling/Coding Error
$8,885
In appeal
Jun 27
CLM-2026-9031
72110 · Medical Necessity
$1,031
In appeal
Jun 24
CLM-2026-5150
71046 · 181d outstanding
$860
Pending payer
Mar 2
CLM-2025-7032
73630 · underpaid 27.5%
$159 short
Recovered
Nov 9