Claim CLM-2026-9014
Patient
- Name
- Owen Gallagher
- Date of birth
- 1950-01-26
- Patient id
- P034
Payer
- Name
- Medicare
- Payer id code
- 00882
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- Jul 21 (denial date, no service date on file)
- Procedure
- 73630, X-Ray Foot, Complete
- Diagnosis code
- M79.671
- Billed amount
- $1,619
Denial
- Reason
- Medical Necessity, code 50
- Date
- Jul 21
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.