Nia Okafor

CLM-2026-9125, Aetna, Chemotherapy Infusion, Addl Hour (96415)

Written offWith me Denied claims

Billed

$5,675

denied Jan 28

Denial risk

90%

a hard one, worth it

Appeal window

closed

nothing left to file

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Imported from a CSV export
Jan 28
Denied by Aetna
Pre-Auth Missing (197)
Jan 28
Heron scored it: 90% denial risk
3 factors found, appeal path chosen
Jan 28
Written off
Every route exhausted
Mar 16

The denial

Pre-Auth Missing, code 197

Patient: Nia Okafor, born 1994-02-22
Payer: Aetna
Procedure: Chemotherapy Infusion, Addl Hour (96415)
Diagnosis: C34.90
Denied on: Jan 28, 2026
Assigned to: Heron

Heron says

High recovery risk (90), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, Aetna auto-denies 96415 without it. 6 similar denials at this facility in the last 90 days for the same reason.

No appeal yet

I can draft one from this claim's history

View the claim form

This claim is settled, so there is nothing left to write.

What I sent

Referral on file

Everything I know about Nia

across every queue

Everything for this patient

Open exposure

$11,019

Recovered

$10,386

6 denied claims2 prior auths2 underpayments3 backlog claims

CLM-2026-5097

96417 · 4d outstanding

96415 · Chemotherapy Infusion, Addl Hour

73630 · 17d outstanding

97530 · Medical Necessity

93000 · underpaid 15.7%

96413 · Chemotherapy Infusion, 1st Hour

97110 · Pre-Auth Missing

93306 · 135d outstanding

96415 · underpaid 7.7%

72110 · Timely Filing

96415 · Pre-Auth Missing

97530 · Bundling/Coding Error

96413 · Medical Necessity

$9,718

Recovered

Nov 19