Claim CLM-2026-9135
Patient
- Name
- Leila Haddad
- Date of birth
- 1964-12-23
- Patient id
- P030
Payer
- Name
- BCBS
- Payer id code
- 00210
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Apr 29 (denial date, no service date on file)
- Procedure
- 96417, Chemotherapy, Additional Sequential
- Diagnosis code
- C18.9
- Billed amount
- $6,314
Denial
- Reason
- Not Covered, code 96
- Date
- Apr 29
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.