Claim CLM-2026-9133

Patient

Name: Yusuf Demir
Date of birth: 1981-02-20
Patient id: P004

Payer

Name: Cigna
Payer id code: 62308

Provider

Name: Northside Medical
NPI: 1982744321

Service

Date of service: Aug 20 (denial date, no service date on file)
Procedure: 72110, X-Ray Lumbar Spine, 4+ Views
Diagnosis code: M54.51
Billed amount: $2,083

Denial

Reason: Medical Necessity, code 50
Date: Aug 20

Appeal

Status: No appeal filed yet

Prepared by Heron on Aug 30.