Claim CLM-2026-9141
Patient
- Name
- Aiko Tanaka
- Date of birth
- 1981-01-08
- Patient id
- P032
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jan 13 (denial date, no service date on file)
- Procedure
- 73630, X-Ray Foot, Complete
- Diagnosis code
- M79.671
- Billed amount
- $2,162
Denial
- Reason
- Bundling/Coding Error, code 97
- Date
- Jan 13
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.