Claim CLM-2026-9126
Patient
- Name
- Grace Mbeki
- Date of birth
- 1980-03-25
- Patient id
- P043
Payer
- Name
- Aetna
- Payer id code
- 60054
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jan 23 (denial date, no service date on file)
- Procedure
- 96417, Chemotherapy, Additional Sequential
- Diagnosis code
- C18.9
- Billed amount
- $2,568
Denial
- Reason
- Medical Necessity, code 50
- Date
- Jan 23
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.