Nia Okafor

CLM-2026-9012, Aetna, Therapeutic Exercise, 15 min (97110)

In reviewWith you Denied claims

Billed

$1,162

denied Jul 9

Denial risk

74%

winnable with the right notes

Appeal window

38d

closes Oct 7

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Entered by hand
Jul 9
Denied by Aetna
Pre-Auth Missing (197)
Jul 9
Heron scored it: 74% denial risk
3 factors found, appeal path chosen
Jul 9
Appeal window closes
38 days left to file
Oct 7

The denial

Pre-Auth Missing, code 197

Patient: Nia Okafor, born 1994-02-22
Payer: Aetna
Procedure: Therapeutic Exercise, 15 min (97110)
Diagnosis: M25.561
Denied on: Jul 9, 2026
Assigned to: Heron

Heron says

Prior authorization was not on file at time of service, Aetna auto-denies 97110 without it. 6 similar denials at this facility in the last 90 days for the same reason. Retro-auth may be available within 30 days of service; escalate to the payer's auth desk.