Claim CLM-2026-9142
Patient
- Name
- Desmond Achebe
- Date of birth
- 1960-06-23
- Patient id
- P005
Payer
- Name
- Medicare
- Payer id code
- 00882
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Apr 4 (denial date, no service date on file)
- Procedure
- 73630, X-Ray Foot, Complete
- Diagnosis code
- M79.671
- Billed amount
- $481
Denial
- Reason
- Missing Information, code 16
- Date
- Apr 4
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.