Claim CLM-2026-9146
Patient
- Name
- Maya Feldman
- Date of birth
- 1991-12-08
- Patient id
- P012
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jul 6 (denial date, no service date on file)
- Procedure
- 70553, MRI Brain w/ and w/o Contrast
- Diagnosis code
- G43.909
- Billed amount
- $2,665
Denial
- Reason
- Missing Information, code 16
- Date
- Jul 6
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.