Claim CLM-2026-9149
Patient
- Name
- Aiko Tanaka
- Date of birth
- 1993-04-13
- Patient id
- P028
Payer
- Name
- UnitedHealthcare
- Payer id code
- 87726
Provider
- Name
- Northside Medical
- NPI
- 1982744321
Service
- Date of service
- May 15 (denial date, no service date on file)
- Procedure
- 72148, MRI Lumbar Spine w/o Contrast
- Diagnosis code
- M51.16
- Billed amount
- $1,524
Denial
- Reason
- Not Covered, code 96
- Date
- May 15
Appeal
- Status
- No appeal filed yet
Prepared by Heron on Aug 30.