Tomas Herrera

CLM-2026-9148, UnitedHealthcare, Chemotherapy, Additional Sequential (96417)

DeniedWith me Denied claims

Billed

$13,977

denied Jun 25

Denial risk

90%

a hard one, worth it

Appeal window

24d

closes Sep 23

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Imported from a CSV export
Jun 25
Denied by UnitedHealthcare
Coverage Terminated (27)
Jun 25
Heron scored it: 90% denial risk
3 factors found, appeal path chosen
Jun 25
Appeal window closes
24 days left to file
Sep 23

The denial

Coverage Terminated, code 27

Patient: Tomas Herrera, born 1968-02-27
Payer: UnitedHealthcare
Procedure: Chemotherapy, Additional Sequential (96417)
Diagnosis: C18.9
Denied on: Jun 25, 2026
Assigned to: Heron

Heron says

High recovery risk (90), prioritize this claim in the appeal queue. Coverage had terminated as of the date of service per UnitedHealthcare eligibility. Re-run eligibility for the service date and check for a successor plan.

No appeal yet

I can draft one from this claim's history

Draft it View the claim form

Open Intelligence, pick this claim, and I write the letter from the denial, the payer's rules and the clinical guideline. You sign it here.

What I sent

Nothing sent yet.

Everything I know about Tomas

across every queue

Everything for this patient

Open exposure

$40,108

Recovered

$24,365

6 denied claims2 prior auths0 underpayments5 backlog claims

CLM-2026-5123

93000 · 3d outstanding

70553 · 3d outstanding

93000 · 4d outstanding

93306 · Missing Information

73721 · 35d outstanding

72148 · MRI Lumbar Spine w/o Contrast

72148 · 37d outstanding

96417 · Chemotherapy, Additional Sequential

96417 · Coverage Terminated

93000 · Bundling/Coding Error

72148 · Bundling/Coding Error

96417 · Medical Necessity

70553 · Bundling/Coding Error

$5,991

Recovered

Nov 25