Claim CLM-2026-9125
Patient
- Name
- Nia Okafor
- Date of birth
- 1994-02-22
- Patient id
- P023
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jan 28 (denial date, no service date on file)
- Procedure
- 96415, Chemotherapy Infusion, Addl Hour
- Diagnosis code
- C34.90
- Billed amount
- $5,675
Denial
- Reason
- Pre-Auth Missing, code 197
- Date
- Jan 28
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.