Heron

Aiko Tanaka

CLM-2026-9149, UnitedHealthcare, MRI Lumbar Spine w/o Contrast (72148)

In appealWith the payer Denied claims
Billed
$1,524
denied May 15
Denial risk
51%
good odds
Appeal window
lapsed
closes Aug 13
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Entered by hand
    May 15
  2. Denied by UnitedHealthcare
    Not Covered (96)
    May 15
  3. Heron
    Heron scored it: 51% denial risk
    3 factors found, appeal path chosen
    May 15

The denial

Not Covered, code 96

Patient
Aiko Tanaka, born 1993-04-13
Payer
UnitedHealthcare
Procedure
MRI Lumbar Spine w/o Contrast (72148)
Diagnosis
M51.16
Denied on
May 15, 2026
Assigned to
Heron
Heron says
Service is excluded under the member's current UnitedHealthcare benefit plan. Verify benefits as of the date of service, plan may have changed mid-year. If non-covered is confirmed, route to patient responsibility rather than appeal.

No appeal yet

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Draft itView 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 Aiko

across every queue
Everything for this patient
Open exposure
$9,273
Recovered
$370
2 denied claims2 prior auths2 underpayments4 backlog claims
AUTH-4063
70553 · MRI Brain w/ and w/o Contrast
77% odds
Pending
Aug 30
CLM-2026-5053
70553 · 3d outstanding
$1,096
In follow up
Aug 27
AUTH-4028
72148 · MRI Lumbar Spine w/o Contrast
64% odds
Pending
Aug 26
CLM-2026-5147
71046 · 4d outstanding
$1,424
Pending payer
Aug 26
CLM-2026-5146
73721 · 27d outstanding
$3,171
Pending payer
Aug 3
CLM-2026-7093
71046 · underpaid 30%
$280 short
Under review
Jul 12
CLM-2026-9005
72110 · Bundling/Coding Error
$1,449
In appeal
Jul 4
CLM-2026-7011
72148 · underpaid 24.2%
$370 short
Recovered
Jun 10
CLM-2026-9149viewing
72148 · Not Covered
$1,524
In appeal
May 15
CLM-2026-5091
71046 · 168d outstanding
$329
Partially paid
Mar 15