Priya Raman

CLM-2026-9151, Medicare, Chemotherapy, Additional Sequential (96417)

In reviewWith you Denied claims

Billed

$2,743

denied Aug 16

Denial risk

47%

good odds

Appeal window

76d

closes Nov 14

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Imported from a CSV export
Aug 16
Denied by Medicare
Bundling/Coding Error (97)
Aug 16
Heron scored it: 47% denial risk
3 factors found, appeal path chosen
Aug 16
Appeal window closes
76 days left to file
Nov 14

The denial

Bundling/Coding Error, code 97

Patient: Priya Raman, born 1955-06-04
Payer: Medicare
Procedure: Chemotherapy, Additional Sequential (96417)
Diagnosis: C18.9
Denied on: Aug 16, 2026
Assigned to: Heron

Heron says

Medicare bundled this line into a primary procedure billed the same day. Modifier review recommended, most bundling denials resolve on corrected resubmission. Verify NCCI edit pairs before resubmitting to avoid a second rejection.

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What I sent

Corrected claim

Everything I know about Priya

across every queue

Everything for this patient

Open exposure

$30,147

Recovered

$2,537

7 denied claims2 prior auths1 underpayment4 backlog claims

AUTH-4024

96417 · Chemotherapy, Additional Sequential

96417 · Chemotherapy, Additional Sequential

97530 · 6d outstanding

96417 · Missing Information

97110 · 8d outstanding

96417 · Bundling/Coding Error

93000 · underpaid 13.9%

96417 · Pre-Auth Missing

97530 · 123d outstanding

96417 · 158d outstanding

96415 · Pre-Auth Missing

96417 · Timely Filing

96415 · Medical Necessity

97110 · Medical Necessity

$1,262

Recovered

Nov 26