Ximena Vargas
CLM-2026-9152, Medicare, Therapeutic Activities, 15 min (97530)
Billed
$700
denied May 2
Denial risk
53%
good odds
Appeal window
closed
nothing left to file
Recovered
$700
the money is back
What I did
and what comes next- May 2Claim reached HeronPosted from the 835 remittance
- May 2Denied by MedicareNot Covered (96)
- May 2Heron scored it: 53% denial risk3 factors found, appeal path chosen
Jul 22Paid in fullThe money is back
Heron says
Service is excluded under the member's current Medicare 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.
Everything I know about Ximena
across every queueEverything for this patient
Open exposure
$897
Recovered
$1,570
1 denied claim1 prior auth1 underpayment1 backlog claim