Heron

Elliot Marchetti

CLM-2026-9150, BCBS, Chemotherapy Infusion, Addl Hour (96415)

In appealWith the payer Denied claims
Billed
$11,350
denied Jun 24
Denial risk
44%
good odds
Appeal window
23d
closes Sep 22
Appeals
0
none filed yet

What I did

and what comes next
  1. Claim reached Heron
    Entered by hand
    Jun 24
  2. Denied by BCBS
    Missing Information (16)
    Jun 24
  3. Heron
    Heron scored it: 44% denial risk
    3 factors found, appeal path chosen
    Jun 24

The denial

Missing Information, code 16

Patient
Elliot Marchetti, born 1979-09-24
Payer
BCBS
Procedure
Chemotherapy Infusion, Addl Hour (96415)
Diagnosis
C34.90
Denied on
Jun 24, 2026
Assigned to
Heron
Heron says
Claim rejected for incomplete data, most often a missing referring provider NPI or member ID mismatch. Member ID on file (INS635017) should be revalidated against the payer's eligibility response. Corrected claims for this reason typically pay within 20 days.

No appeal yet

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What I sent

  • Referral on file

Everything I know about Elliot

across every queue
Everything for this patient
Open exposure
$36,074
Recovered
$0
1 denied claim1 prior auth0 underpayments4 backlog claims
CLM-2026-5129
96417 · 3d outstanding
$6,629
Pending payer
Aug 27
CLM-2026-5166
96417 · 8d outstanding
$3,795
Partially paid
Aug 22
AUTH-4048
96413 · Chemotherapy Infusion, 1st Hour
71% odds
Denied
Aug 13
CLM-2026-5041
96413 · 53d outstanding
$9,524
Pending payer
Jul 8
CLM-2026-9150viewing
96415 · Missing Information
$11,350
In appeal
Jun 24
CLM-2026-5096
96417 · 106d outstanding
$4,776
Partially paid
May 16