Claim CLM-2026-9137
Patient
- Name
- Henrik Lund
- Date of birth
- 2003-11-28
- Patient id
- P026
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jun 15 (denial date, no service date on file)
- Procedure
- 72110, X-Ray Lumbar Spine, 4+ Views
- Diagnosis code
- M54.51
- Billed amount
- $456
Denial
- Reason
- Missing Information, code 16
- Date
- Jun 15
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.