Heron

Ingrid Solberg

CLM-2025-9140, Aetna, Therapeutic Activities, 15 min (97530)

RecoveredWith me Denied claims
Billed
$2,454
denied Nov 21
Denial risk
80%
a hard one, worth it
Appeal window
closed
nothing left to file
Recovered
$2,454
the money is back

What I did

and what comes next
  1. Claim reached Heron
    Imported from a CSV export
    Nov 21
  2. Denied by Aetna
    Pre-Auth Missing (197)
    Nov 21
  3. Heron scored it: 80% denial risk
    3 factors found, appeal path chosen
    Nov 21
  4. Heron
    Paid in full
    The money is back
    Jan 12

The denial

Pre-Auth Missing, code 197

Patient
Ingrid Solberg, born 2002-03-01
Payer
Aetna
Procedure
Therapeutic Activities, 15 min (97530)
Diagnosis
M62.81
Denied on
Nov 21, 2026
Assigned to
Heron

Appeal successful, payment posted

Heron says
High recovery risk (80), prioritize this claim in the appeal queue. Prior authorization was not on file at time of service, Aetna auto-denies 97530 without it. 4 similar denials at this facility in the last 90 days for the same reason.

No appeal yet

I can draft one from this claim's history

View the claim form

This claim is settled, so there is nothing left to write.

What I sent

  • Referral on file

Everything I know about Ingrid

across every queue
Everything for this patient
Open exposure
$21,497
Recovered
$2,454
2 denied claims1 prior auth2 underpayments2 backlog claims
CLM-2026-5035
93000 · 3d outstanding
$2,818
Pending payer
Aug 27
CLM-2026-5127
93306 · 3d outstanding
$641
Pending payer
Aug 27
CLM-2026-7050
93000 · underpaid 20.4%
$499 short
Disputed
Aug 21
AUTH-4066
96415 · Chemotherapy Infusion, Addl Hour
91% odds
Expired
Jul 22
CLM-2026-7085
93306 · underpaid 26.6%
$614 short
Disputed
Jul 18
CLM-2025-9052
96415 · Pre-Auth Missing
$16,925
In appeal
Dec 19
CLM-2025-9140viewing
97530 · Pre-Auth Missing
$2,454
Recovered
Nov 21