Fatima Zahra

CLM-2025-9131, BCBS, Chemotherapy, Additional Sequential (96417)

In appealWith the payer Denied claims

Billed

$8,010

denied Dec 13

Denial risk

61%

winnable with the right notes

Appeal window

lapsed

closes Mar 13

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Entered by hand
Dec 13
Denied by BCBS
Not Covered (96)
Dec 13
Heron scored it: 61% denial risk
3 factors found, appeal path chosen
Dec 13

The denial

Not Covered, code 96

Patient: Fatima Zahra, born 1972-05-30
Payer: BCBS
Procedure: Chemotherapy, Additional Sequential (96417)
Diagnosis: C18.9
Denied on: Dec 13, 2026
Assigned to: Heron

Heron says

Service is excluded under the member's current BCBS benefit plan. Verify benefits as of the date of service, plan may have changed mid-year. If non-covered is confirmed, route to patient responsibility rather than appeal.

No appeal yet

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What I sent

Nothing sent yet.

Everything I know about Fatima

across every queue

Everything for this patient

Open exposure

$32,297

Recovered

3 denied claims1 prior auth1 underpayment4 backlog claims

CLM-2026-5062

73630 · 3d outstanding

93000 · 4d outstanding

96413 · Medical Necessity

93306 · 36d outstanding

96417 · Chemotherapy, Additional Sequential

72110 · 51d outstanding

72110 · underpaid 30.6%

96417 · Missing Information

$8,486

In appeal

Nov 11