Heron

Desmond Achebe

CLM-2026-9128, Medicare, Chemotherapy, Additional Sequential (96417)

RecoveredWith me Denied claims
Billed
$12,355
denied Mar 19
Denial risk
52%
good odds
Appeal window
closed
nothing left to file
Recovered
$12,355
the money is back

What I did

and what comes next
  1. Claim reached Heron
    Posted from the 835 remittance
    Mar 19
  2. Denied by Medicare
    Bundling/Coding Error (97)
    Mar 19
  3. Heron scored it: 52% denial risk
    3 factors found, appeal path chosen
    Mar 19
  4. Heron
    Paid in full
    The money is back
    Jun 3

The denial

Bundling/Coding Error, code 97

Patient
Desmond Achebe, born 1960-06-23
Payer
Medicare
Procedure
Chemotherapy, Additional Sequential (96417)
Diagnosis
C18.9
Denied on
Mar 19, 2026
Assigned to
Heron

Appeal successful, payment posted

Heron says
Medicare 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

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

  • Corrected claim

Everything I know about Desmond

across every queue
Everything for this patient
Open exposure
$16,910
Recovered
$16,885
9 denied claims1 prior auth5 underpayments3 backlog claims
CLM-2026-7007
97530 · underpaid 8.5%
$64 short
Under review
Aug 26
AUTH-4025
96413 · Chemotherapy Infusion, 1st Hour
79% odds
Pending
Aug 25
CLM-2026-9056
93000 · Medical Necessity
$3,018
Denied
Aug 22
CLM-2026-7002
97530 · underpaid 21.7%
$76 short
Disputed
Aug 20
CLM-2026-5015
96413 · 13d outstanding
$7,880
In follow up
Aug 17
CLM-2026-9119
97530 · Pre-Auth Missing
$1,828
Denied
Aug 9
CLM-2026-7052
93306 · underpaid 31.4%
$189 short
Disputed
Aug 8
CLM-2026-9049
93306 · Not Covered
$2,771
In appeal
Jul 11
CLM-2026-5134
97530 · 72d outstanding
$701
Pending payer
Jun 19
CLM-2026-5010
73630 · 134d outstanding
$383
Partially paid
Apr 18
CLM-2026-9142
73630 · Missing Information
$481
Recovered
Apr 4
CLM-2026-9161
97530 · Bundling/Coding Error
$797
Written off
Mar 27
CLM-2026-9128viewing
96417 · Bundling/Coding Error
$12,355
Recovered
Mar 19
CLM-2026-9108
97110 · Coverage Terminated
$1,866
Recovered
Feb 12
CLM-2026-9062
73630 · Medical Necessity
$596
Recovered
Feb 10
CLM-2026-7087
93000 · underpaid 27.3%
$553 short
Recovered
Jan 27
CLM-2025-9006
97110 · Medical Necessity
$875
Recovered
Dec 28
CLM-2025-7077
97110 · underpaid 27.9%
$159 short
Recovered
Nov 1