Claim CLM-2026-9138
Patient
- Name
- Hannah Kowalczyk
- Date of birth
- 1955-05-10
- Patient id
- P022
Payer
- Name
- Medicare
- Payer id code
- 00882
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jan 19 (denial date, no service date on file)
- Procedure
- 73721, MRI Lower Extremity Joint
- Diagnosis code
- M23.61
- Billed amount
- $4,824
Denial
- Reason
- Missing Information, code 16
- Date
- Jan 19
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.