Marcus Oyelaran

CLM-2026-9013, Aetna, Chemotherapy Infusion, 1st Hour (96413)

In appealWith the payer Denied claims

Billed

$2,219

denied Jul 22

Denial risk

36%

good odds

Appeal window

51d

closes Oct 20

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Jul 22
Denied by Aetna
Bundling/Coding Error (97)
Jul 22
Heron scored it: 36% denial risk
3 factors found, appeal path chosen
Jul 22

The denial

Bundling/Coding Error, code 97

Patient: Marcus Oyelaran, born 2001-10-13
Payer: Aetna
Procedure: Chemotherapy Infusion, 1st Hour (96413)
Diagnosis: C50.911
Denied on: Jul 22, 2026
Assigned to: Heron

Heron says

Aetna bundled this line into a primary procedure billed the same day. Modifier review recommended, most bundling denials resolve on corrected resubmission. Verify NCCI edit pairs before resubmitting to avoid a second rejection.

No appeal yet

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What I sent

Corrected claim

Everything I know about Marcus

across every queue

Everything for this patient

Open exposure

$13,149

Recovered

3 denied claims3 prior auths3 underpayments3 backlog claims

AUTH-4020

96413 · Chemotherapy Infusion, 1st Hour

70553 · MRI Brain w/ and w/o Contrast

93000 · 5d outstanding

72110 · Medical Necessity

93000 · underpaid 18.5%

73630 · underpaid 11.2%

96415 · Chemotherapy Infusion, Addl Hour

96413 · Bundling/Coding Error

93000 · 57d outstanding

93000 · 87d outstanding

93000 · Missing Information

72110 · underpaid 6.1%

$87 short

Under review

Apr 18