Claim CLM-2026-9124
Patient
- Name
- Paloma Reyes
- Date of birth
- 1990-03-28
- Patient id
- P013
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jan 29 (denial date, no service date on file)
- Procedure
- 97110, Therapeutic Exercise, 15 min
- Diagnosis code
- M25.561
- Billed amount
- $410
Denial
- Reason
- Pre-Auth Missing, code 197
- Date
- Jan 29
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.